Nursing Clinical Group Placement Requests :: Nationwide Children's Hospital

Nursing Clinical Group Placement Requests

Application for Nursing Clinical Group Placement at Nationwide Children’s Hospital 2016-2017

*Applications for the 2016-2017 academic year will be accepted between January 1, 2016 and February 28, 2016

  • A separate “Application for Nursing Clinical Group Placement” form needs to be completed for each different course.
  • Faculty requesting precepted student placement should use the “Precepted Student Placement” form.
  • Request only the number of placements you need. Please do not attempt to overbook.
  • There is no guarantee of receiving all days, shifts or placements requested.
  • While Nationwide Children’s Hospital attempts to maintain consistency in clinical placement units, placements are not guaranteed from term to term or year to year.
  • Clinical Groups can be assigned to units only with the Program Manager’s approval.
  • No clinical groups will be placed on Sunday or on night shift (11pm-7am).
  • Please request traditional shift times (7am-3pm and 3pm-11pm) for efficiency of scheduling.

     

Nursing Clinical Group Placement Application
Please complete all fields
REQUESTS NOT ACCEPTED UNTIL JANUARY 1, 2016 (for 2016-2017 academic year)
Final deadline for applications is February 28, 2016.
Person completing this form (include title): *
Name of College/School of Nursing: *
Clinical Rotation Description *
Course Name, number and short description: *
Type of program: *
Preferred Clinical Experiences: *
Preferred Pediatric Age Group(s): *
Preferred Patient Acuity: *
Level of Students: *
Will groups be giving direct patient care? *
Yes
No
Will students be giving medications? *
Yes
No
Are Observational Experiences requested? *
Yes
No
Affiliation Request Information
Do any of the terms below split rotations? *
Yes
No
TERM ONE
Select one: *
Term Start Date: *
(Split) End Date:
(Split) Start Date:
Term End Date: *
Total number of group placements requested (each half term is 1 group): *
Number of students per group: *
TERM TWO
Select one:
Term Start Date:
(Split) End Date:
(Split) Start Date
Term End Date:
Total number of group placements requested (each half term is 1 group):
Number of students per group:
TERM THREE
Select one:
Term Start Date:
(Split) End Date:
(Split) Start Date:
Term End Date:
Total number of group placements requested (each half term is 1 group):
Number of students per group:
TERM FOUR
Select one:
Term Start Date:
(Split) End Date:
(Split) Start Date:
Term End Date:
Total number of group placements requested (each half term is 1 group):
Number of students per group:
PLACEMENT PREFERENCES
Preferred days/times of Clinical Affiliation: *
Alternate days/times of Clinical Affiliation: *
Clinical Placement Coordinator
All communications regarding placements will be sent to this person.
Name: *
Email: *
Phone number: *
Course Coordinator
Name: *
Email: *
Phone number: *
Questions?
Please add any additional questions, concerns or comments you have for our Schools of Nursing Coordinator.
Questions or comments:
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000