PRACTICAL NURSING PROGRAM ADMISSION APPLICATION PACKET

FALL 2019

ADMISSIONS TO THIS PROGRAM IS CLOSED FOR FALL 2019

Thank you for your interest in the Practical Nursing Program for Fall 2019. This application packet contains

important information about admission requirements, the admission process, and program requirements for Fall

2019 (Note: these admission requirements are applicable to Fall 2019 only. For subsequent years, admission

requirements are subject to change without notice).

Here are the Steps that must be followed to successfully apply to the program:

STEP 1: READ THE INFORMATION IN THIS PACKET Please read all of the information in this packet carefully and follow all instructions. Admission to this Program

is highly competitive and has a selective admission process. It is your responsibility to assure that you accurately

understand the information in this packet and follow it accordingly.

STEP 2: COMPLETE ALL ADMISSION CHECKLIST REQUIREMENTS The Admission Requirements Checklist in this packet details admission requirements and other important

information. You must complete all checklist items for your application to be considered complete and ready for

review. Please note that it is the applicant’s responsibility for assuring that the application is complete and

received. If any of the required items are incomplete/missing when you submit your application material,

your application will not be processed (i.e. reviewed). We will mail it back to you.

STEP 3: SUBMIT YOUR COMPLETED APPLICATION We will begin taking completed applications on September 24, 2018. All completed applications received

by close of business on February 15, 2019 will be reviewed for potential acceptance to the program.

Completed applications may be considered under the same procedure after this date because space remains

available in the program or waitlist, but there is no guarantee of such consideration. Admission to this program

may close at any time after this date without notice. Thus, the only guarantee of consideration is to have the

completed application submitted within the above dates. Applicants who submit completed applications between

September 24, 2018 and February 15, 2019 will receive written notification of an admission decision in a letter

postmarked by May 1, 2019. If offered admission, a non-refundable $150.00 deposit will be required to secure

your acceptance to this Program.

Walk-in Submission - We strongly recommend that you submit your packet in person. A staff

member will review your packet to ensure it is complete before you leave.

Mail-in Submission - As stated above, it is the applicant’s responsibility for assuring that the application

is complete and received. You can mail the items to us (see the NSCC application form for address).

However, if any of the required items are incomplete/missing when you submit your application material;

your application will not be processed. We will mail it back to you.

ADMISSION REQUIREMENTS CHECKLIST

PRACTICAL NURSING PROGRAM

CHECKLIST INSTRUCTIONS: The last Column of this form is to be completed by the applicant. It identifies

the admission requirements for this program.

Admission Requirements Checklist Checklist Item Important Information Applicant: initial below

when complete (NOTE:

Requirements are considered

incomplete if in progress,

scheduled, or requested)

TEAS Exam –

ATI TEAS

The PN Program prefers that the ATI TEAS exam be taken at NSCC.

Students may only take the test two (2) times in the academic year

prior to submitting their application, regardless of location. Students

whose score reports reflect that they have tested more than 2 times or

at another location other than NSCC must also submit an official

TEAS transcript from ATI: http://www.atitesting.com/ati_store/. The

academic year is September 1 through August 31.

ATI TEAS Minimum required scores: Reading = 69%, Math = 63.3%, Science = 45.8% and English =

54.2%.

Initial: __________

See the TEAS Policy and

procedure document in this

packet for further details on

study/preparation

information.

Communication

s and Math

Proficiency

There are many ways to demonstrate this, including but not limited to:

placement testing, by course work here or at another College, SAT

scores, and some Entrance Exams. For details visit:

http://www.northshore.edu/academics/proficiency/basic_skills.html

Initial: __________

Mandatory

Information

Session

Attendance

Form

Upcoming dates are included in this packet. When you attend the

orientation, you will be given an attendance form to submit with your

application.

Initial: __________

Admission

Reference

Forms

Each reference must be in a separate sealed envelope with the

signature of the author across the seal and submitted with your

packet. A master copy of this form is in this packet, which you will

need to make copies of and distribute to each of the following people

to submit with your application.

immediate supervisor

employer or teacher

friend of at least 2 year’s duration

Note: If you have attended another nursing program, the Program

Director from your former program must also complete and submit an

Admission Reference Form (this is in addition to the three listed

above)

Initial: __________

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Questionnaire The questionnaire is included in this packet. A word-processed

questionnaire must be submitted for the year in which you are

applying.

Initial: __________

High school

transcript or

GED score

report

Submit an official copy of the high school transcript or GED score

report. If you previously submitted the transcript or score report and

attended classes within the past 5 years, then Enrollment likely has it

on file.

Initial and check:

Initial: __________

____ submitted now with

packet of application

material.

____ previously submitted

Program’s

Student

Handbook

The Practical Nursing Student Handbook must be read in its entirety.

This can be accessed in the Library or on the website:

http://www.northshore.edu/academics/programs/pnr/student_handbook

Initial: __________

NSCC

Application for

Admission

This form must be completed for the year for which you are applying;

regardless of whether you are a new or current student (a previously

submitted application does not count).

Initial: __________

Official

transcripts from

all Colleges/

Universities

previously

attended

You must submit official transcripts from all Colleges/ Universities

previously attended. If the College/University will give an official

transcript directly to you, then have them do so. This is the most

efficient way for you to ensure that receipt of transcripts do not

hold up your application. If you have previously submitted

transcripts and have since completed courses or are currently

registered for courses, then you need to submit an updated

transcript.

Transfer students from another NLN accredited school of professional

nursing or practical nursing program or a practical nursing program

approved by the Massachusetts Board of Registration in Nursing:

must also provide an official transcript from previous school of

nursing or practical nursing program within the last 10 years

must also provide course syllabi from all previous nursing courses

will be evaluated for admission and advanced placement in

nursing on an INDIVIDUAL BASIS. An informational interview

may be required by the Department Chairperson.

Initial and __________

check the option(s) that apply

____ submitted with this

packet of application

material.

____ mailed directly to

NSCC

_____previously submitted

(no new courses).

NOTE: The sooner you start

the transfer request process

the better. It has been the

College’s experience that it

can take on average 1-2

months for transcript requests

to be processed and sent to us

from other colleges.

Evaluation Information

Admission decisions are based on careful evaluation of all admission requirements detailed in the checklist. All submitted

transcripts will be evaluated for overall academic performance/history and course work in specific subjects (including but

not limited to science, English, behavioral sciences, health courses and math). Questionnaire evaluation includes but is

not limited to the following: correct grammar/spelling, overall content and quality of answer (e.g. accuracy, thoroughness,

and relevance to the question asked). The application and admission process abides by the college’s policy of non-

discrimination on the basis of race creed, religion, color, gender, sexual orientation, age disability, genetic information,

maternity leave and national origin.

Confirmation Statement

When you can initial every checklist item (on this page and the previous pages) as complete, then sign the

confirmation statement below and submit your application to the Enrollment Center in Lynn or Danvers (submit in

person if possible, but you can mail it to the address on the NSCC application form):

I acknowledge that I have read all of the information in this admission application packet and the Practical Nursing

Program’s Student Handbook in its entirety. I acknowledge that it is my responsibility that I understand all of the

information contained in these items by seeking further information/clarification from an Academic Advisor and/or other

appropriate College personnel. Furthermore, I agree to comply with all College policies including but not limited to

Program policies should I be granted admission to this program.

Signature: ____________________________________________ Date: _________________________

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Additional Important Information

1. If you are accepted you MUST attend a Mandatory Orientation/Registration day scheduled for

Tuesday June 4, 2019. Also, you will be required to attend additional orientation day(s) during the

months of July and/or August, during which time you will receive further important program

information and be orientated to guidelines for patient simulation scenarios. Further information

(including dates/times) for these additional orientations will be given to you at the June 4, 2019

orientation.

2. The program anticipates accepting approximately 40 students for Fall 2019. The decision in

response to your completed application will be: accepted to Practical Nursing; accepted conditionally

to Practical Nursing; or wait list for Practical Nursing; or denied admission to Practical Nursing.

3. Please be advised that students accepted to this program will be required to fully participate in

patient simulation scenarios designed to closely replicate the healthcare workforce environment,

which will prepare students to perform required competencies and care for patients. These scenarios

are video recorded and viewed in debriefing sessions that allow for reflective learning, peer-to-peer

learning, and evaluation by faculty/staff. Students are expected to respect and care for the patient

simulators as if they were live patients, as well as to respect their fellow classmates during scenarios

and debriefing sessions.

4. Anatomy and Physiology 1 (BIO211) & 2 (BIO212) and Microbiology (BIO214) Some students

choose to take the BIO211 and BIO212, and BIO214 courses in place of the HLS102 and HLS104

courses outlined in the Practical Nursing Program. If this is the case, then the following are true :

In order to substitute BIO211 and BIO212 for HLS102, you must have both BIO211 and BIO212

completed with a final grade of C or higher, completed prior to the beginning of the fall semester.

If a student is unable to have both courses completed by that time, then they must take HLS102

during the first semester of the program, regardless of whether they successfully passed BIO211

with a C or higher.

For BIO211, BIO212 and BIO214: these courses must be completed within 10 years of the date of

entry into the Practical Nursing Program in order to use them to meet graduation requirements. If

these courses were completed more than ten years from the date of entry into the Practical Nursing

Program, then the student must also pass the Excelsior College Examination with a cut off score

equivalent to a "C" or better at NSCC (www.excelsior.edu or 888-647-2388) or take the course again

and earn a C or better.

For BIO211: In order to register for this course, you must have completed ONE of the following:

o BIO101 or BIO105 with a grade of C or higher (no time limit)

o LPN Certificate (no time limit)

o Bachelor of Science in Biological Science (no time limit)

o High School Biology with a C or higher within the last 5 calendar years

o CLEP test with a score of 50 or higher within the last 5 calendar years

o AP Biology Test with a 3 or higher within the last 5 calendar years

o Score of 50 or higher on the science section of the ATI TEAS Entrance Exam

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5. Students interested in participating in an academic program that involves working with children, the

disabled, or the elderly, or which includes a clinical affiliation, internship, or field placement with a

private or public health care provider, may be required to undergo a Criminal Offender Record

Information (CORI), and/or Sex Offender Record Information (SORI) check(s), and/or National

County Background Check(s). Depending on the contents of student’s CORI(s) or SORI(s), a

student’s participation in clinical internship or field placement course may not be allowed, and

therefore may impact a student’s ability to complete program requirements. Furthermore, please note

that all screening requirements that occurred during the student’s enrollment in the program do not

presume a guarantee of eligibility to sit for professional credentialing examination(s) or employment in

a medical facility upon graduation.

6. Drug Screening - Student(s) accepted to a Health Profession program and/or enrolled in a health

profession course may be required to undergo a drug screening analysis in order to be eligible for

participation in clinical internship(s). The drug screening(s) may be random or for cause, and the

student will be notified if they are required to undergo such drug screening(s). Students who either fail

to pass, or refuse to submit to, or fail to schedule and take a drug screening analysis within the

designated time frame required in the notification of drug screening, will be deemed ineligible for

clinical placement, which will affect their status in the program. If you have any questions pertaining

to this policy, please contact the Interim Dean of Health Professions, Human Services and Emergency

Response Pathways, Cindy O’Donnell at codonnel@northshore.edu.

7. In order to practice Nursing in Massachusetts, individuals must obtain a license, which according

to law requires that individuals graduate from an approved program of Practical Nursing, apply to the

Board of Registration in Nursing, be of good moral character, pass a licensure examination, and pay

the appropriate fee. The license application requires individuals to answer specific questions about

disciplinary actions (if any), other licenses (if any), and felony/ misdemeanor convictions (if any).

Individuals may need to submit documentation in accordance with the Board’s Good Moral Character

Licensure Requirement Information Sheet. After reviewing information submitted by an applicant, the

Board will determine whether the applicant meets the statutory requirement of “good moral character.”

For additional information, refer to the Board’s web site at: http://www.mass.gov/dph/boards/rn, click

on Licensing, then Good Moral Character Requirements for Licensure.

8. Working as a Practical Nurse is physically, mentally, and emotionally demanding. Applicants

who are offered admission must document their ability to perform all essential tasks with or without

reasonable accommodation in order to begin the professional courses. If you are an otherwise

qualified individual with a disability who seeks a reasonable accommodation, you need to contact the

Office of Accessibility Services for eligibility determination for reasonable accommodation(s). A list

of the essential tasks is in this packet under the section entitled, “Technical Standards for The Practical

Nursing Program”.

9. Health science students must meet immunization requirements under state law, 244 CMR 6.04(3)(a)1

which states that the program shall require all candidates for admission to provide satisfactory evidence of

compliance with the immunization requirements specified by the Massachusetts Department of Public Health.

The requirements can be found here: https://www.mass.gov/files/documents/2016/11/qn/guidelines-adult.pdf.

and in the NSCC Nurse Education Health Packet (see below). Students must also meet any additional

immunization requirements required by clinical affiliates. According to MGL Chapter 76, Section 15C, a health

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science student who is in contact with patients may be exempt from the immunization requirements imposed

under state law pursuant to a medical or religious exemption. Submission of documentation will be required

and, if sufficient to qualify for a medical or religious exemption, it will be granted. PLEASE BE ADVISED

that, while the college will make a reasonable effort to place you in a clinical facility, clinical placement

cannot be guaranteed in light of an un-immunized status. If a clinical placement cannot be secured, then

you will be unable to complete the program's clinical requirement. Thus, you will be unable to progress

and will fail out of the program.

Health and Immunization Requirements

1. Tetanus, diphtheria and pertussis: (TdaP) vaccination required within the past 10 years, then a Tdbooster every 10 years

2. Measles- evidence of two live vaccinations or immune titer results required3. Mumps- evidence of two live vaccinations or immune titer results required4. Rubella- evidence of two live vaccinations or immune titer results required5. Hepatitis B- Evidence of a positive titer or Evidence of a completed two or three part series followed

by titer with positive results6. Varicella (chickenpox) - evidence of two vaccinations or immune titer results required7. Meningitis- Menveo or Menactra dose required after 16th birthday for all newly enrolled students

between 16-21 years old (these vaccines are known as MenACWY, formerly listed as MCV4) or awaiver (see pages 7 & 8).

8. Two Step Tuberculin Skin Test (TST) upon admission or IGRA- serology (T-SPOT or QuantiferonGOLD). One step annual TST test for subsequent years of enrollment.

9. Individuals with positive TST results must complete the NSCC Healthcare Provider Screening Form

required forprovided by the College and submit one chest x-ray report following the positive TST.10. Annual flu vaccine or signed waiver

(A completed Health Immunization Form must be completed and signed by a Health Care Provider and submitted to the Health Compliance Nurse in the month of July for Fall admission and in December for January admission.)

If you are accepted, a Health Packet will be mailed to you and must be thoroughly completed by you and

your health care provider AS SOON AS POSSIBLE, but no later than July 3, 2019. Additionally, if

accepted, you will be sent and will need to sign the Technical Standards form (a copy is included in this

packet for your review as part of the admission application process).

Students are REQUIRED to make a complete copy of their Health Packet before

submitting the original forms.

10. Accepted students will be required to maintain Student Liability Insurance throughout their enrollment

in the program. Information about this process will be provided at the Mandatory Orientation.

11. Prior to beginning clinical placements, students must document that they have CPR certification at theHealth Care Provider level.

12. During the program, students are responsible for their own transportation to a variety of clinicalfacilities (which may or may not be accessible by public transportation).

13. Program Fees – In addition to College-wide tuition and fees, please be advised that a high cost

program fee is applied to this program. In addition to the high cost program fee, other costs may be

incurred to fulfill other program and clinical requirements (e.g. uniforms, stethoscopes, etc.)

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Updated January 2018

Information about Meningococcal Disease, Meningococcal Vaccines, Vaccination Requirements and the Waiver for Students at Colleges and Residential Schools

Colleges: Massachusetts requires all newly enrolled full-time students 21 years of age and under attending a postsecondary institution (e.g., colleges) to: receive a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday to protect against serotypes A, C, W and Y or fall within one of the exemptions in the law, discussed on the reverse side of this sheet.

Residential Schools: Massachusetts requires all newly enrolled full-time students attending a secondary school who will be living in a dormitory or other congregate housing licensed or approved by the secondary school or institution (e.g., boarding schools) to receive a dose of quadrivalent meningococcal conjugate vaccine to protect against serotypes A, C, W and Y or fall within one of the exemptions in the law, discussed on the reverse side of this sheet.

The law provides an exemption for students signing a waiver that reviews the dangers of meningococcal disease and indicates that the vaccination has been declined. To qualify for this exemption, you are required to review the information below and sign the waiver at the end of this document. Please note, if a student is under 18 years of age, a parent or legal guardian must be given a copy of this document and must sign the waiver.

What is meningococcal disease? Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the tissue that surrounds the brain and spinal cord called the “meninges” and cause meningitis, or they can infect the blood or other body organs. Symptoms of meningitis may appear suddenly. Fever, severe and constant headache, stiff neck or neck pain, nausea and vomiting, and rash can all be signs of meningitis. Changes in behavior such as confusion, sleepiness, and trouble waking up can also be important symptoms. In the US, about 1,000-1,200 people get meningococcal disease each year and 10-15% die despite receiving antibiotic treatment. Of those who live, another 11-19% lose their arms or legs, become hard of hearing or deaf, have problems with their nervous systems, including long term neurologic problems, or suffer seizures or strokes.

How is meningococcal disease spread? These bacteria are passed from person-to-person through saliva (spit). You must be in close contact with an infected person’s saliva in order for the bacteria to spread. Close contact includes activities such as kissing, sharing water bottles, sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of someone who is infected and is coughing or sneezing.

Who is at most risk for getting meningococcal disease? High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent complement component deficiency (an inherited immune disorder), HIV infection, those traveling to countries where meningococcal disease is very common, microbiologists who work with the organism and people who may have been exposed to meningococcal disease during an outbreak. People who live in certain settings such as college freshmen living in dormitories and military recruits are also at greater risk of disease from some of the serogroups.

Are some students in college and secondary schools at risk for meningococcal disease? College freshmen living in residence halls or dormitories are at an increased risk for meningococcal disease caused by some of the serotypes contained in the quadrivalent vaccine, as compared to individuals of the same age not attending college. The setting, combined with risk behaviors (such as alcohol consumption, exposure to cigarette smoke, sharing food or beverages, and activities involving the exchange of saliva), may be what puts college students at a greater risk for infection. There is insufficient information about whether new students in other congregate living situations (e.g., residential schools) may also be at increased risk for meningococcal disease. But, the similarity in their environments and some behaviors may increase their risk.

The risk of meningococcal disease for other college students, in particular older students and students who do not live in congregate housing, is not increased. However, quadrivalent meningococcal vaccine is a safe and effective way to reduce their risk of contracting this disease. In general, the risk of invasive meningococcal B disease is not increased among college students relative to others of the same age not attending college. However, outbreaks of meningococcal B disease do occur, though rarely, at colleges and universities. Vaccination of students with meningococcal B vaccine may be recommended during outbreaks.

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Is there a vaccine against meningococcal disease? Yes, there are 2 different meningococcal vaccines. Quadrivalent meningococcal conjugate vaccine (Menactra and Menveo) protects against 4 serotypes (A, C, W and Y) of meningococcal disease. Meningococcal serogroup B vaccine (Bexsero and Trumenba) protects against serogroup B meningococcal disease. Meningococcal conjugate vaccine is routinely recommended at age 11-12 years with a booster at age 16. Students receiving their first dose on or after their 16th birthday do not need a booster. Individuals in certain high risk groups may need to receive 1 or more of these vaccines based on their doctor’s recommendations. Adolescents and young adults (16-23 years of age) who are not in high risk groups may be vaccinated with meningococcal B vaccine, preferably at 16-18 years of age, to provide short-term protection for most strains of serogroup B meningococcal disease. Talk with your doctor about which vaccines you should receive. Is the meningococcal vaccine safe? Yes. Getting meningococcal vaccine is much safer than getting the disease. Some people who get meningococcal vaccine have mild side effects, such as redness or pain where the shot was given. These symptoms usually last for 1-2 days. A small percentage of people who receive the vaccine develop a fever. The vaccine can be given to pregnant women. A vaccine, like any medicine, is capable of causing serious problems such as severe allergic reactions, but these are rare. Is meningococcal vaccine mandatory for entry into secondary schools that provide housing, and colleges? Massachusetts law (MGL Ch. 76, s.15D) and regulations (105 CMR 220.000) requires both newly enrolled full-time students attending a secondary school (those schools with grades 9-12) who will be living in a dormitory or other congregate housing licensed or approved by the secondary school or institution and newly enrolled full-time students 21 years of age and younger attending a postsecondary institution (e.g., colleges) to receive a dose of quadrivalent meningococcal vaccine. At affected secondary schools, the requirements apply to all new full-time residential students, regardless of grade (including grades pre-K through 8) and year of study. Secondary school students must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine at any time in the past, unless they qualify for one of the exemptions allowed by the law. College students 21 years of age and younger must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday, unless they qualify for one of the exemptions allowed by the law. Meningococcal B vaccines are not required and do not fulfill the requirement for receipt of meningococcal vaccine. Whenever possible, immunizations should be obtained prior to enrollment or registration. However, students may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration. Exemptions: Students may begin classes without a certificate of immunization against meningococcal disease if: 1) the student has a letter from a physician stating that there is a medical reason why he/she can’t receive the vaccine; 2) the student (or the student’s parent or legal guardian, if the student is a minor) presents a statement in writing that such vaccination is against his/her sincere religious belief; or 3) the student (or the student’s parent or legal guardian, if the student is a minor) signs the waiver below stating that the student has received information about the dangers of meningococcal disease, reviewed the information provided and elected to decline the vaccine. Where can a student get vaccinated?

Students and their parents should contact their healthcare provider and make an appointment to discuss meningococcal disease, the benefits and risks of vaccination, and the availability of these vaccines. Schools and college health services are not required to provide you with this vaccine. Where can I get more information?

• Your healthcare provider • The Massachusetts Department of Public Health, Division of Epidemiology and Immunization at (617) 983-6800

or www.mass.gov/dph/imm and www.mass.gov/dph/epi • Your local health department (listed in the phone book under government)

Waiver for Meningococcal Vaccination Requirement

I have received and reviewed the information provided on the risks of meningococcal disease and the risks and benefits of quadrivalent meningococcal vaccine. I understand that Massachusetts’ law requires newly enrolled full-time students at secondary schools who are living in a dormitory or congregate living arrangement licensed or approved by the secondary school, and newly enrolled full-time students at colleges and universities who are 21 years of age or younger to receive meningococcal vaccinations, unless the students provide a signed waiver of the vaccination or otherwise qualify for one of the exemptions specified in the law.

□ After reviewing the materials above on the dangers of meningococcal disease, I choose to waive receipt of meningococcal vaccine.

Student Name: _______________________________________ Date of Birth: _________ Student ID: _______________ Signature: __________________________________________________ Date: _________________ (Student or parent/legal guardian, if student is under 18 years of age)

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PRACTICAL NURSING PROGRAM ADMISSIONS QUESTIONNAIRE - FALL 2019

This questionnaire is NOT an application for admission.

Instructions page one: Please complete this page by printing all of your answers. Attach additional sheet(s) if needed

or submit a resume (make sure your name is on each additional sheet).

Name: _________________________________________________ Soc Sec #:_____________________________

Last First MI

Address:_________________________________________________________________________________________

Day Time Phone:_(____)_________________________ Evening Phone:_(____)_____________________________

Cell Phone: (_____)_________________________________Email:_____________________@___________________

Are you applying for advanced placement from another nursing program? Yes No

If yes: RN PN

Please PRINT all answers (or attach a word processed resume):

Your current job:

Dates:

Employer:

Duties and Responsibilities:

Prior job(s)

Dates:

Employer/Facility:

Duties and Responsibilities:

Employer/Facility:

Duties and Responsibilities:

Health Related Experiences or

Site Visits

Dates:

Employer/Facility:

Duties and Responsibilities:

Please proceed to the next page and follow the instructions.

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PRACTICAL NURSING PROGRAM ADMISSIONS QUESTIONNAIRE-FALL 2019 (Continued)

Instructions page two: Please answer all following questions. Evaluation of the answers includes but is not

limited to grammar, spelling, as well as overall content and quality of the answer s (e.g. accuracy, thoroughness,

and relevance to the question asked). Handwritten applications will not be accepted. Make sure your name is on

each of the page(s) submitted.

1. How do you plan to manage your academic commitments and your other commitments while

enrolled in the Program?

How are you planning to balance your life and academic responsibilities so as to optimize your chances

to be successful in this rigorous program?

2. What do you believe is the role of a Licensed Practical Nurse in healthcare today?

Please provide examples of the duties and responsibilities of a nurse.

3. Discuss two policies in the Practical Nursing Student Handbook and the impact they will have on

you while you are in the Program.

4. Currently in Massachusetts, approximately 20% of Licensed Practical Nurses go on to become

Registered Nurses. Other than the purpose of becoming a Registered Nurse, why have you chosen

to enter the Nursing Profession as a Licensed Practical Nurse?

5. Please describe your academic accomplishments and personal attributes that will contribute to

your functioning as a competent Licensed Practical Nurse.

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PRACTICAL NURSING PROGRAM

REFERENCE FORM This section to be completed by the applicant: Applicant’s Last Name:

Applicant’s First Name:

Name of Evaluator/Reference:

Affiliation:

Under the provisions of the Family Education Rights and Privacy Act of 1974, I waive my right of access to this reference form; North Shore Community College may consider it confidential.

Signature of Applicant

Date This section to be completed by the evaluator: The applicant named above has applied for admissions to the Practical Nursing program at North Shore Community College and has listed you as a reference. Please complete this form and return to the applicant in a sealed envelope with your signature across the seal. We assure you that any information given to us will be held in the strictest confidentiality. Thank you. How long and in what capacity have you known this applicant? ________________________________________________________________________________________________ Please carefully assess the applicant in the following areas:

Excellent 1

Very Good

2

Good 3

Fair 4

Poor 5

Unable to

Evaluate Dependability and Reliability Appearance Initiative Motivation Oral Communication Skills Interpersonal Skills Professionalism and Work Ethic Judgment and Critical Thinking Emotional Maturity

Strengths: _______________________________________________________________________________________ Weakness: _______________________________________________________________________________________ Would you recommend this applicant for the program? Yes _____ No _____ If “No” Why? Please feel free to use the reverse side for any additional comments.

Name of Reference: _________________________________________________ Title: _________________________ Signature: _________________________________________________________ Date: ________________________

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TECHNICAL STANDARDS FOR PRACTICAL NURSING

To the student: As you complete this form please consider your physical and mental/attitudinal ability to meet the Technical Standards associated with the health professions program that you are about to enter. Please carefully consider the General Job Description as you evaluate your ability to meet the Technical Standards specified. Contact the P r a c t i c a l Nursing Program at (978) 762-4206, if you require more specific information about the physical and mental/attitudinal requirements of the program. General Job Description: Utilizes the nursing process to participate in assessing, planning, implementing, and evaluating patient needs. Applies critical thinking skills in performing safe, competent nursing care. Communicates effectively with patients, families, and the healthcare team. Instructs patients regarding appropriate health teachings. Throughout the performance of your duties as a healthcare provider, you will be exposed to infectious diseases in all practice settings. Although you will learn practices and procedures to minimize the risk of exposure, you should be aware of the risk and take it into consideration when deciding to enter this program and profession.

Accepted Students: Please sign and return to Health Professions Main Office – DH318

PHYSICAL Performance Level*

LIFT: patients, equipment up to 25 lbs safely F

CARRY/MOVE: equipment, objects up to 25 lbs safely F

KNEEL: to perform CPR, work with patients, assist patients who fall

O

STOOP/BEND/ assist in ADL; perform transfers, operate TWIST: low level equipment

F

BALANCE: safely maintain while assisting patients in ambulation, and transfer

C

CROUCH: to locate and plug in equipment O

REACH: to adjust equipment, to guard patient, to reach supplies

F

WALK: for extended periods of time and distances over an eight (8) hour period

C

STAND: for extended periods of time over an eight (8) hour period

C

HANDLE: equipment such as syringes, Bp cuffs, IV infusions, buttons, switches and touch pads

F

DEXTERITY: to perform fine motor skills, manipulate and fine tune knobs, dials, blood pressure cuffs, equipment, scales and stretchers. Don and remove protective clothing. Safely handle sterile supplies to prevent contamination

F

PUSH/PULL: wheelchairs, stretchers, patients, Hoyer lifts F 18

TACTILE Performance Level*

PALPATE: pulses, skin texture, bony landmarks C

DIFFERENTIATE: between temperature and pressure variations F

VISUAL Performance Level*

READ: accurately read numbers, letters, cursive writing in fine and other print in varying light levels

C

DETECT: changes in skin color, patient’s facial expressions, swelling, atrophy, forms of non-verbal communication (gestures)

F

OBSERVE: patient and environment in order to assess conditions or needs

C

SEE: BP manometer, small print on vials, syringes, dials, gauges and computer screens

C

COMMUNICATION Performance Level*

SPEAK: in English language in clear, concise manner; to communicate with patients, families, significant others and the health care team

C

RESPOND: to patient with communication disorders (aphasia, hearing loss), or those who use ELL

C

COMPREHEND: oral and written language, including health care terminology in order to communicate with patients, families, significant others, health care providers, and community

C

WRITE/WORD PROCESS: in English, clearly, legibly; for charts, computer

input of data

C

AUDITORY Performance Level*

HEAR: heart sounds, breath sounds, patient distress sounds, machine timer bells and alarms; verbal directions and requests from health care team and patients

C

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Updated: 9/12/17

MENTAL/COGNITIVE/BEHAVIORAL Performance Level*

Function safely, effectively, and calmly under stressful situations. F

Remain alert to surroundings, potential emergencies; respond to patient situations, i.e. falls, burns, pain, change in physical status.

F

Integrate information, and make decisions based on pertinent data, in a collaborative manner.

C

Interact effectively, appropriately and exhibit respect for cultural and ethnic difference of patients, peers and individuals in the clinical and classroom settings.

C

Interact effectively and appropriately with patients, families, supervisors, and co-workers of the same or different cultures with respect, politeness, tact, collaboration, teamwork, and discretion in both the clinical and classroom settings.

C

Communicate an understanding of basic principles of supervision, ethics, and confidentiality.

C

Display effective interpersonal skills necessary to interact in situations requiring close, personal contact.

C

Display attitudes/actions consistent with the ethical standards of the profession.

C

Maintain personal hygiene consistent with close personal contact associated with patient care.

C

Maintain composure while managing multiple tasks simultaneously.

C

Prioritize multiple tasks. C

Remain free from alcohol and/or chemical impairment in the clinical and classroom settings.

C

IMMUNIZATIONS

Health science students must meet immunization requirements under state law, MGL Chapter 76, Section 15C and its regulations at 105 CMR 220.000 – 220.700. Students must also meet any additional immunization requirements required by clinical affiliates.

According to MGL Chapter 76, Section 15C, a health science student who is in contact with patients may be exempt from the immunization requirements imposed under state law pursuant to a medical or religious exemption. Submission of documentation will be required and, if sufficient to qualify for a medical or religious exemption, it will be granted. PLEASE BE ADVISED that, while the college will make a reasonable effort to place you in a clinical facility, clinical placement cannot be guaranteed in light of an un-immunized status. If a clinical placement cannot be secured, then you will be unable to complete the program's clinical requirement. Thus, you will be unable to progress and will fail out of the program.

*Performance Level: O = occasionally 50-74%; F = frequently 75-89%; C = constantly 90-100%

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Updated: 9/12/17

*Applicants who are offered admission must document their ability to perform all essential tasks with or without reasonable

accommodation in order to begin the professional courses. If you are an otherwise qualified individual with a disability who

seeks a reasonable accommodation, you need to contact the Office of Accessibility for eligibility determination for reasonable

accommodation(s). For those applicants offered admission into the program, you will be asked to self-certify by signing the

Technical Standards form which is included in the Health Form packet that will be mailed to you and that you are required to

complete no later than July 5, 2018.

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ATI TEAS ENTRANCE EXAM FOR HEALTH PROGRAMS - FALL 2019

For more information: Drop in to either testing center - Danvers DB213 or Lynn LS215 Call 978-739-5550 or email TEAS@northshore.edu

GENERAL INFORMATION The “ATI Test of Essential Academic Skills” (TEAS) is a computerized test composed of multiple-choice questions organized into four sections, which measure reading ability, basic mathematics skills, science and English grammar. It is a timed test published by Assessment Technologies Institute (ATI Testing), LLP. Testers should plan to spend approximately 4 hours at the test center. A four-function calculator is incorporated into the test, dictionaries and other aids are not permitted.

Section # of questions Time allowed Reading 53 64 minutes Key ideas and details, craft and structure, integration of knowledge and ideas. Mathematical Skills 36 54 minutes Numbers and algebra, measurement and data Science 53 63 minutes Human anatomy and physiology, life and physical science, scientific reasoning English and Language Usage 28 28 minutes Conventions of Standard English, knowledge of language, vocabulary acquisition

2019 PROGRAM REQUIREMENTS ATI TEAS Requirements for NSCC Nursing and Allied Health Programs

Program

TEAS Required

Sections Required

Scores Required

Reading Math Science English

Nurse Education (NSG) Yes ALL 69% 73% 59.6% 66.7%

Occupational Therapy Assist. (OTA) Yes ALL 69% * * *

Occupational Therapy Assist. Accelerated (OTX) Yes ALL 69% * * *

Physical Therapist Assistant (PTA) Yes ALL * * * *

Practical Nursing (PNR) Yes ALL 69% 63.3% 45.8% 54.2%

Radiological Tech (RAD) Yes ALL 69% 70% 50.0% *

Respiratory Care (RSP) Yes ALL 65% * * *

Surgical Technology (SRG) Yes ALL * * 50% *

* Section is required but no minimum score has been determined. Lowered from 60.4 on 2/25/2019

NOTE: Respiratory Care and Surgical Tech requires that the ATI TEAS test be taken at North Shore Community College Lynn or Danvers Campus. Nurse Education and Practical Nursing programs highly recommend that the ATI TEAS test be taken at North Shore Community College Lynn or Danvers Campus.

ELIGIBILITY Any individual may take the ATI TEAS test at the Center for Alternative Studies and Educational Testing. However, students may only take the test two (2) times in the academic year prior to submitting their application regardless of location. Students whose score reports reflect that they have tested more than 2 times or at another location other than NSCC, must also submit an official TEAS Transcript from ATI: http://www.atitesting.com/ati_store/. The academic year is September 1 through August 31.

REGISTERING and PAYING FOR THE TEST The ATI TEAS test is offered on a regular basis in Lynn and Danvers. To access the schedule go to www.atitesting.com and follow the instructions below. Click ‘Register for the ATI TEAS’ then select Massachusetts and either Lynn or Danvers to see the dates and times available. Space is limited, and more sessions are added as sessions fill. It is recommended that applicants for the Fall Semester of 2019

Center for Alternative Studies & Educational Testing

22

prepare for the exam early and register to take the test as soon as they feel prepared. Registration and payment for the ATI TEAS test are done online. Registrations are final.

To view available testing dates, register and pay: Go to www.atitesting.com.

Log into ATI or create an ATI account if you don’t already have one.

Follow the prompts to “Register for the ATI TEAS.”

Choose Massachusetts and then either Lynn or Danvers to view NSCC’s TEAS schedule. More dates are added as sessions fill.

Select your test date and enter your credit card information.

Payment is due online at the time of registration. The fee is $94 per test.

Payment is NON REFUNDABLE and ALL TEAS REGISTRATIONS ARE FINAL so be sure that you have read the admissions packet thoroughly and that you are ready to test on the date scheduled.

You will receive an email confirmation of your testing appointment. You will need your ATI Username and Password on the date of testing.

If you need help registering for the TEAS, call ATI at 1-800-667-7531. PREPARATION for the ATI TEAS Students are strongly encouraged to prepare for this exam. Be sure to use the ATI TEAS Study Manual version 6. The TEAS test was revised on August 31, 2016 so the TEAS V Manual is now outdated. The ATI TEAS Study Manual and online practice tests are available at www.atitesting.com. The book is also available in the reference section of the NSCC libraries or for sale at the NSCC College Bookstores. NSCC also offers non-credit prep courses for the ATI TEAS test. For more information, consult the college website or call Corporate and Community Ed at (978) 236-1200.

ADMISSION TO THE TEST Report to ROOM LS215 (Lynn) or ROOM DB213 (Danvers) fifteen minutes before the start time of the test. Students arriving late will not be admitted to the testing session and must pay the $94 testing fee to reschedule. The following are required for admission to your TEAS testing session:

A photo ID (valid driver’s license or school ID with photo)

Your ATI username and password

SCORING Students receive their individual ATI TEAS score reports immediately upon completion of the exam. Students can also access their score reports by logging into www.atitesting.com. Students must submit a copy of the scores with their completed application packet.

RETEST POLICY Applicants to health programs may take the test a total of two (2) times in the academic year prior to submitting their application. Students should not take the test unless properly prepared. See Preparation above for more information. If a student takes the test a third time, the Admissions office will deem these scores invalid and testing fees will not be refunded.

CONFIDENTIALITY The Center for Alternative Studies and Educational Testing will not provide information to any external sources regarding an individual’s test scores unless written permission is received from the student. This policy is in accordance with the student confidentiality policy of North Shore Community College.

ACCOMMODATIONS Accommodations are available to students with documented disabilities. NSCC Students should speak with their accessibility counselor. Non-NSCC students must provide NSCC’s Accessibility Services with documentation of their disability. For more information visit www.northshore.edu/accessibility or contact Accessibility Services at 978-762-4000 x 4501. Documentation must be received at least 2 weeks prior to the test date. Students planning to test with accommodations should create an account on ATItesting.com but NOT schedule an exam until after contacting the testing center.

ACADEMIC DISHONESTY Dictionaries or other aids are not permitted on the TEAS test. Other rules are posted throughout the Testing Center. Students who fail to comply with these rules face disciplinary action according to NSCC student guidelines. Disciplinary action may include: forfeited test scores, ineligibility for refunds, and the student may be deemed permanently ineligible for services of the testing center.

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MANDATORY INFORMATION SESSIONS

FOR APPLICANTS TO

PRACTICAL NURSING PROGRAM

Applicants to the Practical Nursing Program must attend an information session. Please come to learn more about the admissions process and the program. Please come prepared to ask questions. This information should enable you to make a more informed decision about the Practical Nursing Program. Information Sessions are held in the Health Professions and Student Services building on the Danvers Campus (One Ferncroft Road, Danvers). The application packet can be obtained in the Enrollment Center in Danvers or Lynn or on the website on the Practical Nursing Program’s web page.

2019 SPRING SESSIONS

Monday, January 7, 2019 in DH-226 @ 3:00pm Monday, February 11, 2019 in DH-227 @ 4:00pm

Monday, March 4, 2019 in DH-227 @ 9:00am Monday, April 8, 2019 in DH-227 @ 3:00pm Monday, May 6, 2019 in DH-227 @ 9:00am

Tuesday, May 28, 2019 in DH-226 @ 4:00pm Monday, July 8, 2019 in DH-227 @ 4:00pm

Pamela Quinlan, Program Director

(978) 762-4206 Email: pquinlan@northshore.edu

Last Updated: 6/18/19