Practical Nursing Program Overview (LPN)

Completion of the recommended courses includes a pre-clinical sequence, followed by two twelve-week and one six-week semesters. Clinical experience in area institutions will supplement classroom theory learning by providing nursing practice in a variety of settings, including hospitals, nursing homes, and community health care facilities. The curriculum is designed for individuals with a high school diploma or G.E.D who meet all other academic requirements of the College and the Practical Nursing Program.

The curriculum moves from the simple to the complex, with each course providing foundation information necessary for successful progression to the next semester. For that reason, students must move through a prescribed curriculum and may not take courses out of sequence. Successful completion of all first semester courses is a prerequisite for enrollment in the second semester. Students will be dropped from the program for grades less than “C” in nursing and support courses. In addition to maintaining a grade of “C” in nursing and general education courses, a requirement for completion of the curriculum is satisfactory evaluation in each clinical area.

Additionally, students must complete a final comprehensive nursing exam and earn a passing grade on a final dosage calculation examination that is given to confirm that exit criteria have been met for graduation and employment eligibility.

Practical Nursing Curriculum Outline

• Before acceptance into the PN program the following criteria must be met:
• Satisfactory completion of all remediation courses per CUNY policy.
• Minimum grade of C or better in all Pre-Clinical courses.
• Cumulative GPA of 2.5 minimum in Pre-Clinical phase Key Courses.
• Overall GPA of 2.5.
• Assessment Testing for Practical Nursing Students (given once student has been accepted into the clinical phase)

Total Practical Nursing Credits  = 29
Total General Education Credits  =19
Total Curriculum Credits              = 4 8 

Basic Skills Pre-requisites

*CSE094/095, ENG099, **CSE098/099, ENG099, MAT 096. (pre-requisite for SSY101needed for SSY240) All Clinical learning experiences will be held in area health care facilities. All nursing courses must be taken in sequence. All course descriptions, as well as pre-and co-requisites can be found in the college catalog.

Current laws generally permit a state licensing board or agency to deny a license to practice nursing if the applicant has been convicted of a felony or other specified crime. Like many state licensing boards, the Office of the Professions of the New York State Education Department requires that a criminal background check be conducted prior to granting a license to practice nursing. Questions should be directed to the NYS Office of Professions at www.op.nysed.gov. 

The Nursing Program at LaGuardia Community College does not require a criminal background check, but the educational requirements include placement at one or more hospitals or other off campus clinical training sites, and these sites frequently require a student to undergo a criminal background check before the student can be placed for clinical learning experience. If, based upon the results of a criminal background check, the site determines that a student's participation in its clinical training program would not be in the best interest of the site, the site may deny that student admission to the training program. Even if the student has already begun the placement when the results are received, the site may elect to dismiss the student, regardless of the student's performance while in the training program.

Each clinical training site that requires a criminal background check sets its own standards and procedures, and you may be asked by the site to pay the cost of the background check. You may also have to complete more than one criminal background checks during the course of the Nursing program at LaGuardia Community College, depending on the number of sites where you are placed and the requirements of each site.

Please note that if a clinical training site determines that you may not take part in its training program based on the results of a criminal background check, you may be unable to complete your course requirements and to continue in the Nursing program. It is important for you to consider this before you enroll in the Nursing program. LaGuardia Community College has no obligation to refund your tuition or fees or to otherwise accommodate you in the event you are ineligible to complete your course requirements based on the results of a criminal background check, or if you are denied a license to practice nursing.

The philosophy of the Practical Nursing Program is in accordance with the philosophy of LaGuardia Community College and the Department of Health Science and expresses the faculty’s beliefs about human beings, health, nursing, nursing education and role of the practical nurse in society. In acknowledgement of changing health care needs in the Greater Metropolitan area, the curriculum is designed around the belief that a practical nurse can perform tasks and provide client care by using the tools of case-finding, health teaching and counseling. The faculty believes that the practical nurse must be committed to promoting and maintaining health by providing therapeutic supportive, rehabilitative and evaluative services to human beings under the supervision of a registered nurse. Practical Nursing is a creative, imaginative service-oriented occupation, encompassing a high degree of responsibility, accountability and competency with emphasis placed upon promoting and maintaining high level wellness of human beings within a holistic context.

Further, nursing education is the framework for learning and learning is a natural, dynamic process that enables the student to acquire knowledge, integrate new information, develop rational thought processes, analyze problems and make effective decisions. Nursing education should foster a life-long process of self directed inquiry to meet individual needs and goals, and learning is a life long endeavor which is constantly evolving as a result of the rapidly changing technological advances in the environment. As a result, the dramatic changes in the roles and responsibilities of the Practical Nurse warrant a curriculum that is academic, career-oriented in nature and is flexible and adaptable to the needs of the unique student population. Therefore, an educational experience, based on previously acquired basic concepts and skills is needed to enable interested men and women to become Practical Nurses, without unnecessary delays or barriers.

The dynamic state of nursing education justifies the need for continuous formal and informal experiences. In order to prepare practical nursing students to be part of the health care team and to provide services to the individual, the family and the community, specific principles of education will be applied and adhered to throughout the educational process of the program. The nursing educator, as a facilitator of the learning process, encourages students’ individual initiative and independence of thought. Practical Nursing students will be encouraged to inquire, analyze, synthesize and generalize in order to prepare them to make relevant contributions to society. The curriculum accomplishes this by integrating the fundamentals of biological and applied sciences learned in the Liberal Arts and Sciences Core courses, Maslow’s Hierarchy of Basic Human Needs, the Nursing Process and Critical Thinking Development in all Nursing Clinical Core courses.

The curriculum is based on the premise that society is a social system of interrelated subsystems (individual, families, groups and communities) interacting with the environment to meet specific human needs. Society encompasses a multicultural facet uniquely engaging in interaction for the purposes of education, the transmission of values and the mutual protection and welfare of all people. Therefore, the individual is an integrated whole whose behavior is motivated by the drive to seek satisfaction of basic human needs as theorized by Maslow (1970). As a part of a family, group, community and society, the individual exists in a complementary relationship with the environment and is affected by change within it. The main components of the practical nursing education experiences must include provision of direct client care, counseling individuals and families, applying health concepts across the lifespan within a culturally and spiritually sensitive domain and embodying technology into all facets of practice.

The nursing educator, as a facilitator of the learning process, encourages students’ initiative and independence of thought. Practical Nursing students who are encouraged to inquire, analyze, synthesize and generalize will be prepared to be critical thinkers who will be able to make relevant and significant contributions to the global community in which he or she will practice upon graduation.

The faculty believes practical nursing students need exposure to global community and crosscultural awareness to succeed in the workplace or to transition into professional nursing education. Therefore, the faculty believes that society is a global system of interrelated subsystems (individual, families, groups and communities) interacting with the environment to meet specific human needs. The global society encompasses a multicultural facet uniquely engaging in interaction for the purposes of education, the transmission of values and the mutual protection and welfare of all people. The faculty believes that the individual is an integrated whole whose behavior is motivated by the drive to seek satisfaction of basic human needs as theorized by Maslow (1970). As a part of a family, group, community and society, the individual exists in a complementary relationship with the environment and is affected by change within it.

In keeping with its practical focus, the program avoids redundancy and duplication of theory content, and promotes smooth educational mobility for students as they seek to growth in their chosen profession. The students in the program will be prepared to become safe, effective health care providers in the 21st century using three major concepts. It is the belief of the faculty that when these concepts are integrated throughout the teaching-learning process the graduate of the program will be able to provide competent, holistic client care utilizing critical thinking skills and the nursing process. Therefore, the common frameworks for nursing education in both classroom and clinical practice are:

1. Maslow’s Hierarchy of Basic Human Needs 

   Abraham Maslow's Hierarchy of Needs is one of the conceptual framework providing, the threads that support the curriculum of the Practical Nursing Program. Maslow (1970) described his theory of Human Motivation as a hierarchy of human needs (see table below). To help us understand people, he established a system of categorizing needs from basic to those of a higher level. Human needs are arranged according to priority (prepotency). When needs that have the greatest priority, are satisfied, the individual is capable of reaching higher level needs. As physiological needs are satisfied, higher needs emerge. A strong interrelationship exists among the five levels, and Maslow does not mean to imply that complete satisfaction of each level must be met before the next level of needs emerge.

   
   
     

   SELF-ACTUALIZATION 

   Need to be self-fulfilled, learn, create, understand, and experiences one’s potential _____________________________________________________________________________ 

   ESTEEM 

   Need to be well thought of by oneself, as well as by others _____________________________________________________________________________ 

   BELONGINGNESS AND LOVE  

   Need for affection, sense of belonging and having meaningful relationship with others _____________________________________________________________________________ 

   SAFETY NEEDS 

   Need for safety, freedom from harm and danger Feeling of well-being _____________________________________________________________________________ 

   PHYSIOLOGICAL NEEDS  

   Need for oxygen, rest and activity, nutrition (food & fluid)
   Hygiene, sleep, sexuality (needed for the survival of humankind) _____________________________________________________________________________ 

   Adapted from Maslow, Abraham (1970). Motivation and Personality. (2nd Ed.) Harper and Row, p. 26.  

   
   
   

   In the provision of care to clients, the clinical students will focus on meeting the common daily needs of clients as theorized by Abraham Maslow. These include: needs for oxygen, nutrition and fluids, elimination, sleep and rest, personal care and hygiene, safety and environment, physical activity and exercise, emotional needs, spiritual needs, diversional and rehabilitational needs, needs for physical or social adjustments, needs for safety and effective medical care and treatment. These twelve general areas are basic or common to all clients across the lifespan. They form the basis for the delivery of nursing care that will be planned and provided for during the student’s practical nursing education at LaGuardia Community College.

2. Nursing Process 

   Florence Nightingale (1946) stated that nothing but observation and experience will teach us the ways to maintain or assist the client back to a state of health. The Nursing Process provides the means by which this can be done in an organized, deliberate and concise manner. It is an ongoing systematic procedure by which the nurse determines the client's problems, develops a plan to resolve these problems, implements the plan and evaluates the outcome (Yura & Walsh, 1983). It is a decision-making process, including both cognitive and activity components. The whole process is dynamic and interactive, since data from one phase can aid in maintaining or altering the other phases. The methodology for carrying out the conceptual framework throughout the practical nursing curriculum will be the Nursing Process utilizing the established steps of the process which are assessment, planning, implementation and evaluation. The expectations is that students will utilize the nursing process through the curriculum as outline below:

   ASSESSMENT Method:	Collection and Analysis of Data Establishes a therapeutic nurse-client relationship Collects client health data by obtaining subjective and objective data Reviews previously collected data Collaborates with other health team members Utilizes appropriate resources and collaborate with the professional nurse to interpret data Identifies client problems from data collected
   PLANNING Method:	Determination of priorities, setting goals and developing a plan of care to meet patient needs. Collaborates with the professional nurse in establishing an individual plan of care for assigned clients.
   IMPLEMENTATION Method:	Nursing intervention according to the established plan of care. Implements the interventions identified in the plan of care and documents the outcomes.
   EVALUATION Method:	In collaboration with the professional nurse reviews the effectiveness of the plan of care and modifies according to changing needs. A continual problem-solving approach in close consultation with the professional nurse.

3. Critical Thinking 

   All learning involves thinking that should be developed and nurtured in all students and faculty. Critical thinking techniques involve higher reasoning strategies as foundation of knowledge structuring. Such strategies are used to receive information, interpret it, relate it and adapt it to performances in various circumstances. According to Facione (1998) critical thinking is a pervasive and purposeful phenomenon. In developing critical thinking in students one must take into consideration both core critical thinking skills, as well as the disposition toward critical thinking as illustrated by the following diagrams.

   
   

   Core Critical Thinking Skills                               The Disposition Toward Critical Thinking 

    

   
   

   Facione, Peter (1998) Critical Thinking; What It is and Why it Counts, The California Academic Press, Millbrae, CA, pp 5& 8 

    

   • Inquisitiveness with regard to a wide range of issues 
   • Concern about becoming and remaining well-informed 
   • Alert to the opportunities to use critical thinking 
   • Trust in the processes of reasoned inquiry 
   • Exhibits self-confidence in one’s own abilities to reason 
   • Open-mindedness regarding divergent world views 
   • Flexible in considering alternatives and opinions 
   • Tolerant of the opinions of other people 
   • Fair-mindedness in appraising reasoning 
   • Honesty in facing and dealing with one’s own biases, prejudices, or stereotypes 
   • Prudence in suspending, making or altering judgments 
   • Willing to reconsider and revise views where reflection suggests that change is needed.

   Adapted from Facione (1998) Critical Thinking; What It is and Why it Counts, p. 8. 

Following successfully completion of the Practical Nursing Program, graduates will achieve the identified educational goals and career objectives:

• Perform basic nursing skills utilizing the Nursing Process, operationalizing the skills and knowledge acquired in working with culturally and ethnically diverse clients.
• Utilize critical thinking skills in formulating positive conclusions in the context of nursing practice.
• Collaborate with other health care team members in the coordination and delivery of nursing care and services.
• Conduct themselves in an appropriate manner as defined within the framework of the Nurse Practice Act.
• Utilize effective communication skills in interviewing, observing, reporting and recording as they interact and develop therapeutic relationships with individuals, families and communities.
• Provide supportive and restorative care, including case-finding, health teachings, health counseling and provision of supportive and restorative care under the supervision of a registered professional nurse, legally authorized physician, dentist or other licensed health care provider legally authorized.
• Impart knowledge in areas of prevention of disease, maintenance of well-being and adaptation of illness.
• Use technology in a competent, caring and safe manner in the delivery of nursing service.
• Apply the principles of leadership in a variety of health care settings within the framework of the Nurse Practice Act.
• Accept responsibility for own professional action and growth and facilitate the professional growth of others.

The faculty believes that in order to accomplish the above educational goals and career objectives as well as provide competent, wholistic client care utilizing critical thinking skills and the nursing process the graduate of the practical nursing program must possess the ability to assume the following roles:

• Perform basic nursing skills utilizing the Nursing Process.
• Conduct themselves in an appropriate manner as defined within the framework of the Nurse Practice Act.
• Utilize appropriate communication skills in interviewing, observing, reporting and recording.
• Provide supportive and restorative care including case finding, health teachings, and health counseling under the supervision of a registered professional nurse or legally authorized physician.
• Impart knowledge in areas of prevention of disease, maintenance of well-being and adaptation of illness.
• Apply the principles of leadership in a variety of health care settings within the framework of the Nurse Practice Act.
• Accept responsibility for own professional action and growth and facilitate the professional growth of others.
• Utilize critical thinking skills in formulating positive conclusions as it relates to their nursing practice.
• Take and pass the NCLEX-PN licensure examination.

Applicants to practical nursing program must complete admission requirements of the College and the Registrar insures that all documents are accurate. All students are admitted directly to the pre-clinical phase of the Practical Nursing Program. Progression to the clinical phase of the program is competitive; therefore, students should be striving to maintain an acceptable GPA.

New Freshmen  

Applicants who have never attended college are admitted to the pre-clinical phase provided they meet the college criteria pertaining to the admission of any new freshman applicant to LaGuardia, i.e.: possess a high school diploma or its equivalent GED (General Equivalency Diploma). Applicants who have earned a U.S. Armed Forces Institute diploma must submit proof of having earned a total score of 225 on the GED examination.

Transfers from other Colleges (Advanced Standing)  

The practical nursing program will accepts applicants who have previously attended or graduated from another accredited college or university provided they meet the same basic requirements for new freshmen and as per the LaGuardia College requirement. 

Applicants must have a minimum GPA of 2.50. Applicants may, upon submission of official college transcripts, receive transfer credit only for the following general education courses which are required in the Practical Nursing Program curriculum:

Credit for any above courses taken and passed elsewhere may be granted only if the courses are deemed comparable to those, which meet the certificate requirements of the Practical Nursing Program. The Admissions Office through the appropriate academic departments and in accordance with established college policies and procedures would determine transferable credits. The Practical Nursing Program will follow the transfer policy of the College as it appears in the College catalog. Transfer credit for clinical phase nursing courses will not be awarded.

Transfer From Other Majors Within LaGuardia (In-House Transfer)  

LaGuardia students enrolled in an academic program other than Practical Nursing may file for a change of major provided they have been a student at LaGuardia for at least one enhanced semester and have a minimum GPA of 2.50. The candidate for a change of major must submit the following to the Practical Nursing Program Director:

• Current copy of his/her LaGuardia transcript
• Change of Major Form
• Have taken 1 key courses and achieve a C average or better in each course.

Performance on the NCLEX-PN examination has been shown to correlate positively with a student performance during the clinical phase of a nursing program. Therefore, high standard for progression during this phase of the program must be maintained. The Program’s Committee on Retention and Progression, headed by the Program’s Director, will make the final decision for retention and progression in the program. Once admitted and prior to start of first clinical course faculty of the program will meet each student who achieved candidacy. Comments and recommendations because of this meeting will be written into an established file. Strengths, weakness and needs for close academic support will be noted and both student and faculty will develop a plan for academic support of the student throughout the educational experience in the Program.

To be eligible for progression into the clinical phase of the practical nursing program, a student must meet the following requirements:

In order to advance into nursing clinical coursework, (Application for candidacy in the PN or RN Programs), students must provide documentation in one of the following categories:

1. Satisfactory completion of all remediation courses per CUNY policy

2. Registered as a pre-clinical practical nursing major (Curriculum Code 431)

3. Earned at least a 2.5 grade point average in each pre-clinical key courses.

4. Registered for Practical Nursing Candidacy (LPN000.4199) in the Spring Session I (for entrance in the Fall). Key courses should either be completed or will be completed by the end of this 12-week session.

   THERE IS A DEADLINE TO APPLY FOR LPN CANDIDACY . IT IS THE STUDENT’S RESPONSIBILITY TO CHECK THE ACADEMIC CALENDAR FOR THIS DATE. THE STUDENT CAN ONLY REGISTER FOR CANDIDACY IN THE REGISTRAR’S OFFICE. THE UNDECLARED HEALTH SCIENCE MAJOR WILL CHANGE TO LPN MAJOR (LPN 431) ONCE YOU HAVE BEEN ACCEPTED INTO THE CLINICAL PHASE. 

5. Key Courses Cumulative GPA of 2.5 While a GPA of 2.5 in the key courses is the minimum requirement for consideration, it does not guarantee progression to clinical courses. Seats are competitive and they are determined by a rank order scoring system. No grade lower than a "C" will be accepted for any required science course throughout the Practical Nursing Program. Science course with a C-, D+, D, D- grade may be repeated with permission from the Academic Chair of the Natural Science Department. When key course with grades of C-, D+, D, D- F are repeated, the C-, D+, D, D- F grade and the repeated course grade will be calculated in the key course average.

6. Completed Health Screening as required by clinical affiliated agencies.

7. Attend a mandatory program orientation seminar upon acceptance into the clinical phase

8. Beginning with the Fall 2009 semester in order to advance into nursing clinical coursework, (Application for candidacy in RN or PN Programs), students must provide documentation in one of the following categories: 

   • US Citizenship
   • Permanent residency
   • International student with F1 status
   • Granted asylum, Refuge Status, Temporary Protected Status, Withholding of Removal, Deferred Enforced Departure, or Deferred Action Status by the U.S. government.
    

Please Note: the CUNY Citizenship and Immigration Project provide free counseling and assistance to all CUNY students who need help with their immigration status. For more information, visit: web.cuny.edu/about/citizenship.html 

When students are notified that they have earned a seat in SCL101 additional requirements must be met. The medical form including lab results and immunization dates must be submitted, as well as a current CPR (BCLS for Health Care Provider) card. Malpractice insurance must be purchased; assessment exams must be paid for and taken.

The selection of candidates for the clinical phase of nursing will be determined in the Spring Semester. Students will only be automatically granted 2 chances to apply for candidacy.

To maintain progression during the clinical phase of the program, a student must complete each nursing course with a minimum grade of “C”. A minimum GPA of 2.5 must be maintained throughout the clinical phase. Failure of either the theoretical, college lab or clinical practicum component of any course requires that the entire course be repeated. Student may only repeat a course once with the permission from Program Coordinator. Permission to repeat a course in any of the nursing semester sequence will be basis on space availability. Students repeating a course for the second time must receive a “C+” (77 or better) in order to remain in the program. Within one month of your final grade submission you are required to submit a written letter requesting permission to repeat the one clinical course you have failed. Failure of two courses (SCL 101, 102 or 103) in the first semester of the clinical phase will terminate you from the program.

The standards for clinical nursing progression are:

1. A student must complete each nursing course with a clinical component with a minimum grade of C. If not, he or she must apply for permission to re-register for the course within one year of the original registration.
2. A minimum GPA of 2.5 must be maintained throughout the clinical phase.
3. Failure of either the clinical or theoretical component of any course requires that the entire course be repeated. Student must then submit a letter requesting re-entry into the program to the Program Coordinator. Failure of any two courses will result in termination of the program.
4. Students who have failed, withdrawn or taken a medical leave from a clinical course for a second time are no longer eligible to continue in the Practical Nursing Program.

Students who do not successfully complete SCL 101, SCL 102 or SCL103 for reasons that they (1) declined admission, (2) withdrew officially, (3) withdrew unofficially, (4) took a medical leave, or (5) received a failure after completing the final exam, may be readmitted. Readmission to the course will be at the discretion of the Practical Nursing Program faculty. Students repeating a course for the second time and receive a failing grade, will not be able to continue in the Practical Nursing Program. Faculty will take into consideration test grades, clinical performance and extenuating circumstances.

Once a student is admitted into the clinical phase of the Practical Nursing Program, deferment will only be considered on an individual basis. Confirmation will be given to students who can provide documentation as to why they are unable to enter the program at the time of candidacy. Deferment will only be granted once. Students who are unable to begin in the Fall class must then re-apply for candidacy for the following Spring semester. Students who are permitted to defer, must begin within the next starting class. (the following Fall semester)

1. Assigments

   All assignments are due on the designated date. Failure to comply will result in a lower grade of 5 points for each day of lateness.

2. Attendance

   Students are expected to arrive to all schedule learning activities (Class, College Lab and Clinical sessions) on time and remain for the entire schedule sessions. Attendance policies for class are those stated in the LaGuardia College Catalog: “ the maximum number of unexcused absences is limited to 15% of the number of class hours.” Attendance for the hospital clinical laboratory and the campus laboratory is mandatory. Students who are ill on a clinical day must notify both the faculty member, and the clinical facility, and PN Program secretary at (718)482-5774. Student must provide a doctor’s note /medical clearance to return to class. If a student misses clinical for any reason they must complete a case study or lab assignment to make-up for their clinical absences.

3. Study Time
   It is expected that students spend at least two hours in outside study for each hour spent in class. In nursing, it is also important for students to practice skills in order to perform them safely in the hospital. Therefore, students who carry a full credit load each semester must be prepared to spend 30-40 hours per week in class or studying.

4. Campus Learning Laboratory
   The learning laboratory is used by students to practice and perfect skills, after they have been taught by their instructor in the regularly scheduled campus lab. The learning laboratory is open to all practical nursing students during the hours posted. Students should feel free to come to practice any skills necessary. A college laboratory technician will be available to answer questions or review students' demonstrations. The laboratory is to be used only by nursing students in the clinical phase.

5. Child Care Services
   Practical Nursing students in addition to academic study, lead very busy lives that often include work, family and social obligations. The Practical Nursing Program want our students to have the most supportive environment possible so they can successfully accomplish their educational goals. Therefore, students are encourage to take advantage of the college’s high quality on-campus childcare program and an on-campus pre-K through 2nd Grade School, where your young children can be near you and receive a top-notch education themselves. The Early Childhood Learning Center is located in the M Building.

6. Clinical Facilities
   Students can be expected to be assigned to any health facility in the Greater Metropolitan area. All students are required to provide their own transportation to and from these facilities. Students may be required to submit to a drug testing as well as a background check in order to comply with requirements of assigned clinical facilities

7. The Campus Learning Laboratory: E-358, E-351, E-352, E-361, E-360
   The learning laboratory is used by students to practice and perfect skills after they have been taught by their instructor in the regularly scheduled campus lab. The learning laboratory is open to all nursing students during the hours posted. Students should feel free to come to practice any skills necessary. No appointment is required. A college laboratory technician is available to answer questions or review students' demonstrations. The campus media laboratory was renovated in August 2007 through a grant of $100,000 from HIP Health Plan/Centralized Laboratory Services LaGuardia Community College. The computer and media resource facility provides academic support through computerized internet access, software and video tutorials utilizing state-of-the-art drop-down computers, with integrated live instructor conferencing and smart board interfacing.

8. Clinical Laboratory
   Clinical day from 8:00 am to 4:00 pm or 4pm-11pm, unless otherwise designated. Students may be expected to submit to drug testing in order to comply with requirements of the clinical facilities. In addition, the Program Director may be asked to release students’ social security numbers to affiliating agencies.

9. Conduct and Responsibilities
   Nursing students are legally responsible for their own actions during clinical experiences. Students must be assigned appropriate activities and be given reasonable guidance and supervision while carrying out those activities. In order to fulfill their responsibilities to their assigned clients, nursing students must:

   • be prepared to carry out previously learned skills in a competent manner,
   • ask for help and supervision when needed,
   • document completely and accurately,be familiar and comply with the policies of the agency and
   • be familiar and comply with the policies of the Practical Nursing Program.

   Inappropriate behavior and/or attitude toward faculty, healthcare facilities staff or peers will not be tolerated. Professional classroom and clinical behavior must be maintained at all times. If a student is experiencing difficulty, he or she should make arrange to speak with assigned faculty member and/or a college counselor.

10. CPR Training & Certification
    All students are responsible for scheduling and completing CPR certification training for Healthcare Professional prior to entering the clinical phase of the program. No student will be allowed into the clinical area without CPR certification.

11. Uniform Supplies
    Please refer to the following website for a description of the Practical Nursing Program uniform: www.meridys.com 

    Instructions to order uniforms:  

    Go to the above web address. Enter pass code: LPN2025. Select GO. A stethoscope, pen light and scissors are required for the Practical Nursing Program, but do not have to be ordered from this site. Students must also purchase a watch with second increments.

12. Dress Code Clinical & Campus Laboratory 

    Women 

    Uniform may be either an A-line skirt or elastic/string pants. If a skirt is chosen, its hem must be below knee length. Top must be white with a zipper and optional long sleeved, jewel neck knit tee with Spandex can be worn underneath uniform top. Only white shoes with stockings/socks are acceptable. Clogs, sneakers, or high heels are not acceptable. The LaGuardia Practical Nursing Program patch is already included on the uniform top. Head wear worn for religious reasons should conform to the uniform colors (white).

    Men: 

    The uniform consists of a light blue pants with draw string waist and white zipper top. The LaGuardia Practical Nursing Program patch is already included on the uniform top. White shoes with white socks must be worn.

    Name pins must be worn at all times in the assigned facility and campus clinical. Please refer to website for full description of uniforms and name pins.

    Full uniform must be worn during clinical, campus clinical and all practical exams. 

    • Sweaters or jackets are NOT to be worn with uniforms while on the resident/client care units.
    • Shoes and stockings must be in good repair and clean at all times.
    • Identification badges must be visible on the uniform at all times.
    • Only one pair of stud earrings is to be worn. A watch with the ability to read in increment of second must be worn at all times. No other jewelry is allowed except for a plain Wedding Band.
    • Hair must be worn off the collar.
    • No strong perfume or perfume scented shaving lotion or deodorant.
    • Fingernails are to be filed short and kept clean at all times. No artificial nails permitted.
    • No nail polish should be used in acute care settings.
    • Men are to be clean-shaven or have a neatly trimmed beard and/or mustache.
    • Each student must carry a pen with black ink, bandage scissors, penlight, and a stethoscope.
    • Students who come to the clinical setting improperly attired or unprepared for their clinical assignment will be dismissed by their clinical instructor and counted absent.

    Uniforms Supplies 

    Each student must purchase the following items:
    Stethoscope, bandage scissors, penlight and watch with second increments

    Female 

    • 1 Zipper Top w/collar (white) - Patch included
    • 1 (Optional) Long sleeved, jewel neck knit tee with Spandex to be worn under uniform top
    • 1 Elastic Waist Pants (blue)– Cargo Pkt Or
    • 1 Unisex D-String Waist Pants (blue)-Cargo Pkt Or
    • 1 A-Line Skirt (blue)
    • 1 Navy Pin
    • All white nursing shoe, closed back and toe

    Male 

    • 1 Zipper Top w/collar (white) – Patch included
    • 1 Unisex D- String Waist Pants (blue)
    • 1 Navy Pin
    • All white nursing shoe, closed back
     

Students should read this document before taking their exam.

• It is your responsibility to arrive on time for the exam. If you arrive late for an exam, the student forfeits the time they are late. No extra time will be given for students arriving late.
• Use the restroom before the exam is given out. For a unit exam you will not be permitted to use the restroom
• For the final exam, you may use the restroom only if accompanied by the second faculty or staff member.
• Turn off cell phones completely (do not put them on vibrate).
• No borrowing or sharing calculators
• No using cell phones or PDA’s as a calculator
• The only material that can be used during your exam: #2 pencils, calculator, blank scrap paper (during math quiz only). Please note that all scrap paper must be turned in to faculty with the completed quiz.

All personal belongings will be placed in front of the room. This includes:

• Cellular, mobile, smart phones, PDA
• Any electronic device
• Bags, purses, wallets
• Books, study material
• Cameras
• Coasts, hats, scarves, gloves
• Food or drink
• Gum or candy
• Lip balm

You will be allowed:

• 68 minutes for a 50 question exam
• 136 minutes for a 100 question exam

Make a thorough review your exam and scantron good before turning in your exam. Answers written on test papers, but not placed on scantron, will not be scored.

When you are finished with your exam:
Either brings the scantron to the desk in the front of the room and immediately leave the room or raise your hand and a faculty member can pick the exam and scantron from you.

All Nursing Students should be aware that any disclosure of examination items before, during or after the examination is a violation of the college’s Academic Integrity Policy.

After the exam is reviewed in class, students will have the opportunity to make an appointment to review their unit exams with their instructor for a period of 2 weeks. Students will not be allowed to review the final exam until after grades and attendance have been posted. Instructors will hand score the final exam at the request of any student who fails the course.

ATI is a mandatory component of the Practical Nursing Program. Students who do not complete the ATI assessment and review program will not be eligible for graduation. ATI mandatory review for the NCLEX examination will take place after graduation in June. All must attend this review. There are no exceptions. 

Assessment & Review Program

The ATI (Assessment Technologies Institute) assessment & review program provides students with an ongoing assessment or areas of weakness and strength, along with immediate self-direction remediation assistance. The remediation consists of both text and computerized testing with feedback using the Internet. The program consists of the following components:

1. Test of Essential Academic Skills
   A secured exam consisting of 5 sub-tests
   a. Mathematics b. Reading c. English d. Science e. Language Usage
   This test is given at the start of the program before any content instructions are provided. This enables faculty to identify and work with those students who may have potential challenges with the curriculum.
2. Critical Thinking Entrance & Exit Exams
   a secured non-nursing critical thinking diagnosis exam, which covers:
   a. Interpretation b. Analysis c. Evaluation d. Explanation e. Inference
   This test is given at the start of the program before any content instructors are provided, and at the end of the program. This enables the program to track critical thinking as an outcome criterion.
3. Self-Assessment
   a secured exam consisting of 4 subtest.
   a. Critical Thinking b. Learning Styles c. Professional Characteristics d. Work Values
4. Content Mastery Series Exams
   Eight (8) secured diagnostic exams that score for content, nursing process, critical thinking, knowledge level and NCLEX-PN correlation at the end of each content area. These are:
   a. Fundamental b. Medical-Surgical c. Pharmacology d. Mental Health
   e. Nursing Care of Children (Pediatrics) f. Maternal/Newborn g. Nutrition h. Management
5. Student Exams
   Five (5) unsecured exams is available to students via any computer that has an Internet connection. These exams are interactive tests that include rationale for correct answer and distracters. They include:
   a. Fundamental b. Medical-Surgical c. Nursing Care of Children d. Maternal/Newborn e. Mental Health
6. Practical Nurse Comprehensive Predictor
   This is a secure exam given at the end of the program, which diagnoses and predicts student's ability to be successful on the NCLEX PN license exam.
7. Review Modules
   Seven (7) review modules (study guides) are provided. Research has shown that review and remediation throughout the program are more effective than intensive reviews at the end of student's schooling. The modules are designed to be utilized at orientation and at the end of each course of study, and are distributed after secured diagnostic testing has been given. Modules include:

   1. Orientation Module: Provides an introduction to critical thinking through case study, study skills, not taking, textbook annotation and test-taking skills.

   2. Case Study Review Modules: Provides Lecture, content and application are based on case study scenarios. A detailed lecture manual for instructors and 5 study review manuals for the students. They are:

      1. Fundamental
      2. Medical/Surgical
      3. Mental Health
      4. Nursing Care of Children
      5. Maternal/Newborn
       
   3. State Board Preparation Module: In this module each student will be provided with:
      1. Review of individual performance on the predictor exam
      2. NCLEX test-taking skills
      3. NCLEX testing procedures
      4. Case studies
       
    

Once the student is under the umbrella of the Comprehensive Assessment & Review program, if he or she fails the NCLEX-PN license exam, he or she will have access to ATI resources and any of the above mentioned material for up to one year after graduation.

The Nursing Program has formulated the following Advanced Standing LPN to RN Pathway for licensed practical nurses utilized as of Fall II of 2006.

Following the NYS Coalition for Education Mobility’s Articulation Model, LPN’s may be admitted to the Registered Nurse Program after meeting the following criteria.

All applicants are required to:

1. Have a current LPN registration (licensure)

2. Receive academic advisement to assure that the applicant meets the admission requirements of the Associate Degree Registered Nursing Program (AAS Degree).

3. Successfully complete the NY Coalition for Educational Mobility LPN to RN Transition course.

4. Complete CUNY on-line admissions application to LaGuardia, and transfer or complete the clinical pre-requisite courses: ENG 101, SSY 101, SSY240, SCC210, SCB 203, SCB 204 and SCB 260 and MAT 120.

5. upon completion of clinical pre-requisite courses, a GPA of 2.75 is the minimum requirement to apply for candidacy ( LRN000. 4799) for the LPN to RN Bridge Course ( SCR 100).*

*The applicant may register for the SCR 100, LPN to RN Bridge Course no more than twice (Course may be repeated only once). The applicant must apply for permission from the Nursing Program Director to re-register for the course within one year of the original registration. The student must register for SCR 270 within one semester of the successful completion of the SCR 100, LPN to RN Bridge course.

The LPN TO RN Bridge course (SCR100) will include advanced Psych-Mental Health and Medical-Surgical Nursing content. Students who enter the clinical phase of nursing at SCR 270 level will be required to complete all other nursing requirements in sequence. 

Students who enter the Nursing Program will be expected to adhere to the “Nursing Program Progression Standards” 

Credits That May Be Transferred into the LPN to RN Advanced Pathway 

Upon successful completion of all of the above requirements,the Registered Nursing Program will evaluate and select students applying for the LPN to RN Bridge course based on GPA (minimum of 2.75) and available space. Seventy-five percent of the applicant pool will be candidates from LaGuardia Community College’s LPN Program. Twenty-five percent of the pool will be candidates from outside the college.

Student ranking for admission into the Advanced Pathway 

1. Transfer pre-requisite course grades from outside colleges will be calculated in the GPA ranking.

2. Both general education and nursing clinical course grades will be calculated in the GPA ranking for students who have graduated from the LGCC PN program.

STUDENTS SELECTED WILL RECEIVE 15 EXEMPTION CREDITS GRANTED TOWARD AAS DEGREE UPON COMPLETION OF THE FOLLOWING TWO COURSES:

NY Coalition for Educational Mobility Transition and Bridge Course (SCR100)course: 

• Total 15 Exemption Credits: (Fundamentals of Nursing [SCR 110] Perspectives of Nursing [SCR150] Psychiatric Mental Health Nursing [SCR200] and Medical Surgical Nursing 1 [SCR 210]

Current laws generally permit a state licensing board or agency to deny a license to practice nursing if the applicant has been convicted of a felony or other specified crime. Like many state licensing boards, the Office of the Professions of the New York State Education Department requires that a criminal background check be conducted prior to granting a license to practice nursing. Questions should be directed to the NYSOffice of Professions.

The Nursing Program at LaGuardia Community College does not require a criminal background check, but the educational requirements include placement at one or more hospitals or other off campus clinical training sites, and these sites frequently require a student to undergo a criminal background check before the student can be placed for clinical learning experience. If, based upon the results of a criminal background check, the site determines that a student's participation in its clinical training program would not be in the best interest of the site, the site may deny that student admission to the training program. Even if the student has already begun the placement when the results are received, the site may elect to dismiss the student, regardless of the student's performance while in the training program.

Each clinical training site that requires a criminal background check sets its own standards and procedures, and you may be asked by the site to pay the cost of the background check. You may also have to complete more than one criminal background checks during the course of the Nursing program at LaGuardia Community College, depending on the number of sites where you are placed and the requirements of each site.

Please note that if a clinical training site determines that you may not take part in its training program based on the results of a criminal background check, you may be unable to complete your course requirements and to continue in the Nursing program. It is important for you to consider this before you enroll in the Nursing program. LaGuardia Community College has no obligation to refund your tuition or fees or to otherwise accommodate you in the event you are ineligible to complete your course requirements based on the results of a criminal background check, or if you are denied a license to practice nursing.

Professional obligations are a part of ethical codes that govern the behavior of the members of a profession. Ethical behavior goes beyond the actual client setting. It should be a part of one's life. In addition to nursing students' rights, there are nursing students' responsibilities. These responsibilities require student behavior that maintains the integrity of the profession and the safety of clients.

The following behaviors may lead to dismissal of students:

• Unexcused absences beyond the maximum according to college policy (see College Catalog).
• Any performance or negligence, which causes physical or emotional injury to a client.
• Unprofessional conduct.
• Failure to immediately report a client-care error to clinical instructor and /or responsible staff nursing personnel.
• Being under the influence of alcoholic beverages, drugs which impair judgment, or illegal drugs.
• Fraudulent or untruthful charting in a medical record.
• Dishonesty, e.g. stealing from the college or a clinical agency, plagiarism, cheating on examinations (refer to Program’s and College’s Academic Integrity Policy).
• Failure to improve documented unsatisfactory clinical performance after counseling and remediation.
• Determination of any “direct threat” – This condition consists of a significant risk to the health or safety of a student(s) or patient (s) with a high probability of substantial harm that cannot be eliminated by reasonable accommodation.

*These are estimated expenses and are subject to change*

1. Financial Aid
   In view of the many hours that are required to be successful in nursing, outside employment is discouraged. Students should make every effort to seek financial aid if necessary. The LaGuardia Financial Aid Office is located in C-107.

2. Good Standing
   A student who has satisfactorily met the requirements and standards of the program and the college is considered in good standing.

3. Grading
   A minimum of C in each theory subject and a satisfactory evaluation for clinical and laboratory performance must be maintained. Student progress will be evaluated periodically by the faculty. Students not maintaining C or receiving unsatisfactory clinical performance will be counseled and placed on warning or probation. Grading policies for each course are included in the course Syllabi. The following grading system for the clinical component is in effect:
   93 - 100 = A
   90 - 92.4 = A-
   87 - 89.4 = B+
   83 - 86.4 = B
   80 - 82.4 = B-
   77 - 79.4 = C+
   73 - 76.4 = C
   0 - 72.4 = F

4. Graduation Exercise

   Students will participate in the college graduation ceremony as scheduled.

5. Grievance Procedures
   It is the intent of the program to encourage the timely and informal resolution of student grievances as they occur and to provide a set of procedures leading to satisfactory disposition of complaints. Grievances should be resolved at the earliest possible step. Students may bring a complaint when there has been a violation, misinterpretation or inequitable application of policy or procedure. The procedure for the resolution of complaints is as follows:

   STEP 1	Student will make a formal written or verbal complaint to the faculty member in question. A conference should be arranged to resolve the issue.
   STEP 2	If unresolved, the student will register said complaint with course coordinator and a conference will be arranged with the affected parties to resolve the issue.
   STEP 3	If unresolved, the student will make a formal written to Program Director. Program Director will listen to complaint and respond in writing with a decision within three days.
   STEP 4	Complainant may accept decision of Program Director or appeal decision to Program’s Grievance Committee.
   STEP 5	If a resolution is not agreed upon the grievant may appeal to the Chairperson of Natural & Applied Science Department.
   STEP 6	Complainant may accept decision of Chairperson of Natural & Applied Science Department or appeal decision to College’s Academic Standing Committee.

   
   

   The complainant may at any step request representation from the student council. 

6. Group Concerns
   Students who face problems or have issues to raise during a course should not wait until the end of the semester to voice concerns. At the start of each semester, every class or section of a class will elect a representative to bring any concerns of that group to the nursing faculty.

7. Health Center
   The Health Center provides an array of student centered services including, but not limited to health counseling, first aid and emergency care. The Center now has a Nurse Practitioner on staff that is willing to provide physical examination service. Student must contact the Center for further information located in room MB-40 or phone (718) 482-5280

8. Learning Community Activities
   Independent study commensurate with society's well being in that it fosters critical thinking and encourages students to be self-reliant and responsible. Many tools are used to promote and foster independent study among students. These include, but are not limited to the following:

   • Individual and group learning projects
   • Computer assisted instruction,
   • Viewing of multimedia modalities
   • Collaborative Programmed Learning
   • Research study projects
   • Field visits to health-related agencies.
    

9. Leave Absence (Withdrawal)
   A student in good standing may request a leave of absence for reasons of personal, health, or family situation. The student will be accepted back semester following leave of absence approved by Practical Nursing Director as space allows.

10. Library Facilities
    The Library Media Resources Center at LaGuardia Community College is open for on-site use and borrowing of materials to anyone holding a currently valid ID from any college of the City University of New York (CUNY), any CUNY-affiliated school, and the Empire State College of the State University of New York (SUNY). The Library is located in the E-Building.

11. Malpractice Insurance
    All practical nursing students are required to purchase malpractice insurance. Applications for this insurance will be distributed prior to the start of the first clinical practical nursing course. A valid insurance policy is essential prior to the first clinical day and must be kept current throughout all clinical courses.

12. Meetings
    Student/Faculty:
    Meeting will be held monthly between students and faculty to address recommendations and issues of concern. Minutes must be taken and submitted to Practical Nursing Director’s office for review and filing in a timely fashion.

13. Program Completion Requirements 
    Upon successful completion of the Practical Nursing Program each student will be issued a certificate of graduation and referred to sit for the New York State Practical Nursing Licensure Examination. To successfully complete the program, the following requirements must be met:
    Academic Requirements: Each course must be successfully completed with a minimum grade of C in each course and each clinical practicum must be passed with a satisfactory grade.

14. Students with Disabilities 
    Students with disabilities are admitted to the Practical Nursing Program and progress through the program provided they are able to meet all required course objectives and the LaGuardia Community College Essential Nursing Program. (see Appendix A)

15. Student Health 
     

    1. Physical Examination
       All students must have completed and documented the required physical examination form prior to being assigned to the clinical area.

    2. Health Status
       Students must inform their clinical instructor of any change in health status i.e. pregnancy, physical jury, or medical conditions that impairs physical function before accepting a clinical assignment. The faculty will consider the health and safety of both students and clients when determining clinical assignments. The college and nursing faculty reserve the right to require a physician's statement regarding students' health status if physical function may be impaired at anytime during the clinical rotation. Students maybe required to submit a letter of medical clearance from their Primary Care Provider.

    3. Submission of Forms
       All necessary medical forms and laboratory results must be submitted to the Practical Nursing Program at least two weeks before the first clinical day. If the forms are not submitted on time students will be unable to attend the clinical component of the course, which will affect the course grade. Physical examination forms will be given out at Candidacy Orientation

    4. Health Center is located in room MB-40. The center provides health counseling, First Aid and emergency

    Students with disabilities are admitted to the Practical Nursing Program and progress through the program provided they are able to meet all required course objectives and the LaGuardia Community College Essential Nursing Program. (see Appendix A)

     

16. Student Identification Cards
    Student College’s identification be worn at all times in the clinical area and produced upon request by clinical agency security and/or staff.

17. Student Progress (Evaluations)
    Formal review of student’s academic progression will be done periodically with student during each semester by assigned practical nursing faculty.

18. Student Resposibilities in the Clinical Area
    Practical Nursing students are legally responsible for their own actions during clinical experiences. Students will be assigned appropriate activities and be given guidance and supervision while carrying out assigned client care activities. In order to fulfill their responsibilities to their assigned clients, practical nursing students must:  

    1. be familiar and comply with the policies of the Practical Nursing Program
    2. be prepared to carryout previously learned skills in a competent manner
    3. ask for help and supervision when needed
    4. document accurately and completely on all assigned clients and
    5. be familiar and comply with polices of the assigned clinical agencies

     

1. Two student nurses will be selected and notified by faculty to administer medications one week prior to their assigned medication administration clinical day. These students will then be required to go to the lab and practice medication administration during that week. Students are responsible to bring a medication drug book to each clinical session.

2. The student nurses selected to administer medications will be given the names of the assigned patients by faculty during preconference. The student nurses will be expected to review meds (in the drug guide prior to the administer of said medications) related to:
   A. trade and generic name 
   B. purpose of medication
   C. therapeutic dose range
   D. side affects
   E. nursing implications
   F. contraindications/drug interactions

3. The student nurse will introduce self and identify the patient using two forms of ID as per facility protocol – usually name and DOB or MR #.

4. The student nurse will review the Medication Administration Record (MAR) against the physicians orders selecting medications to be given at the assigned hour. The student nurse will be supervised by faculty as medication administration nursing interventions are determined based on the MAR.

5. After introducing self and identifying the patient (asking patient name, ID Band and two forms of ID -e.g. name and date of birth).

6. The student nurse will be expected to do a quick general assessment of patient and environment (V/S .IV fluid infusion, IV site, dressing, oxygenation etc.) and ask if they need any assistance prior to medication administration.

7. The student nurse will examine the chart and obtain information (diagnosis, activity, IV and diet. Also examines for any contraindications to giving medications, ie NPO, allergies, HR, B/P contraindications.

8. The student nurse will review the MAR a second time, consulting with the clinical faculty/primary nurses to determine if any changes occurred in medications to be given. The student nurse needs to alert the primary nurse prior to removing the medication drawer from the medication cart if this is possible. Computerized carts may not permit removal of drawers.

9. 1. The student nurse will select the medication to be administered from the drug cart by against the MAR and identifying at minimum, the 6 rights of medication administration:

      1. RIGHT PATIENT NAME: patient name on the drug is compared to the MAR

      2. RIGHT DRUG NAME - Drug name on the MAR matches the drug being administered as written on the physician’s order.

      3. RIGHT DOSE - The printed amount of the drug on the MAR to be administered matches the physician’s order and subsequently confirmed on pill encasing.

      4. RIGHT ROUTE - The route written on the MAR matches the physician’s order.

      5. RIGHT TIME – The time written for drug administration on the MAR matches the physician’s order.

      6. RIGHT DOCUMENTATION is utilized on the MAR following the administration. Faculty observes documentation on MAR based on hospital policy.

       

   2. The student nurse will obtain medication from the draw beginning the required three checks only under the supervision of faculty. The student nurse will check and identify the medication:

      1. when it is removed from the drawer;

      2. as it is placed in the medication cup/syringe; and

      3. when the packaged is opened and again at the time of administration to patient.

       
    

10. Prior to entering the room, the student nurse will review the process of patient identification and administration of drug once more with the faculty.

11. The student nurse is expected to wash hands prior to identifying the patient correctly once again just prior to medication administration using the patient’s ID bracelet and two identifiers (e.g. name and date of birth).

12. The student nurse will be supervised by faculty in:

    1. Taking vital signs (ex: pulse and or B/P) if required prior and after administration and chart same;

    2. Showing the patient the drug and teaching the patient about the purpose of the drug, the ordered dose and any special administration requirements. The student nurse will have MAR in hand;

    3. Administering PO medications along with water or appropriate liquids (e.g. orange juice to increase absorption of iron, no milk that could decrease absorption of iron, etc.);

    4. Remaining with the patient until the medication is taken;

    5. Never leaving meds unattended unless they are in a locked medication cart/room.

    6. Documenting the medication administration, signing off with LAGCC SN in the appropriate section followed by faculty co-signature;

    7. Observing the patient 15-30 minutes following medication administration for any side effects;

    8. Observe the hospital time frame for administering medications (e.g. 30 min to 1 hour) and

    9. Informing the faculty and primary nurse of any negative patient responses and/or problems that develop.

     

THE FOLLOWING STUDENT BEHAVIORS MAY LEAD TO PROGRAM DISMISSAL (INVOLUNTARY PROGRAM WITHDRAWAL)
 

• Unexcused absences beyond the maximum according to college policy (see College Catalog).

• Any performance or negligence which causes, or puts the patient at risk for, physical or emotional injury

• Unprofessional conduct (See Rules of the NYS Board of Regents, Part 29, UnprofessionalConduct)

• Failure to immediately report a patent-care error to clinical instructor and /or responsible staff nursing personnel

• Being under the influence of alcoholic beverages, drugs which impair judgement, or illegal drugs

• Fraudulent or untruthful charting in a medical record.

• Dishonesty, e.g. stealing from the college or a clinical agency, plagiarism, cheating on examinations (see Policy on Academic Integrity).

• Failure to improve unsatisfactory clinical performance following counseling.

• Determination of any “direct threat” - This condition consists of a significant risk to the health or safety of a student(s) or patient(s) with a high probability of substantial harm that cannot be eliminated by reasonable accommodation.

REFERENCE: Registered Nursing Student Handbook: General Information and Policies.