Master of Science in Nursing  

Practicum Experience Plan

Overview:

Your Practicum experience includes working in a clinical setting that will help you gain the knowledge and skills needed as an advanced practice nurse. In your practicum experience, you will develop a practicum plan that sets forth objectives to frame and guide your practicum experience.

As part of your Practicum Experience Plan, you will not only plan for your learning in your practicum experience but also work through various patient visits with focused notes as well as one (1) journal entry.

Complete each section below.

Part 1: Quarter/Term/Year and Contact Information

Section A

Quarter/Term/Year:

Student Contact Information

Name:

Street Address:

City, State, Zip:

Home Phone:

Work Phone:

Cell Phone:

Fax:

E-mail:

Preceptor Contact Information

Name:

Organization:

Street Address:

City, State, Zip:

Work Phone:

Cell Phone:

Fax:

Professional/Work E-mail:

Part 2: Individualized Practicum Learning Objectives

Refer to the instructions in Week 2 to create individualized practicum learning objectives that meet the requirements for this course. These objectives should be aligned specifically to your Practicum experience. Your objectives should address your self-assessment of the skills found in the “PMHNP Clinical Skills Self-Assessment Form” you completed in Week 1.

As you develop your individualized practicum learning objective, be sure to write them using the SMART format. Use the resources found in Week 2 to guide your development. Once you review your resources, continue and complete the following. Note: Please make sure each of your objectives are connected to your self-assessment. Also, consider that you will need to demonstrate how you are advancing your knowledge in the clinical specialty.

** YOU MUST HAVE 3 NEW OBJECTIVES EACH QUARTER. You may include previous practicum objectives; however, you still must have 3 new objectives for your current course.

Objective 1: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

· (for example) Develop professional plans in advanced nursing practice for the practicum experience

· (for example) Assess advanced practice nursing skills for strengths and opportunities 

Objective 2: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

·

Objective 3: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

·

Part 3: Projected Timeline/Schedule

Estimate how many hours you expect to work on your Practicum each week. *Note: All of your hours and activities must be supervised by your Preceptor and completed onsite. Your Preceptor will approve all hours, but your activities will be approved by both your Preceptor and Instructor. Any changes to this plan must be approved.

This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.

I intend to complete the 144 or 160 Practicum hours (as applicable) according to the following timeline/schedule. I also understand that I must see at least 80 patients during my practicum experience. I understand that I may not complete my practicum hours sooner than 8 weeks. I understand I may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.

	Number of Clinical Hours Projected for Week (hours you are in Practicum Setting at your Field Site)	Number of Weekly Hours for Professional Development (these are not practicum hour)	Number of Weekly Hours for Practicum Coursework (these are not practicum hours)
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Total Hours (must meet the following requirements)	144 or 160 Hours

Part 4 – Signatures

Student Signature (electronic): Date:

Practicum Faculty Signature (electronic)**: Date:

** Faculty signature signifies approval of Practicum Experience Plan (PEP)

Submit your Practicum Experience Plan on or before Day 7 of Week 2 for faculty review and approval.

Once approved, you will receive a copy of the PEP for your records. You must share an approved copy with your Preceptor. The Preceptor is not required to sign this form.

© 2020 Walden University 3

,

Master of Science in Nursing  

Practicum Experience Plan

Overview:

Your Practicum experience includes working in a clinical setting that will help you gain the knowledge and skills needed as an advanced practice nurse. In your practicum experience, you will develop a practicum plan that sets forth objectives to frame and guide your practicum experience.

As part of your Practicum Experience Plan, you will not only plan for your learning in your practicum experience but also work through various patient visits with focused notes as well as one (1) journal entry.

Complete each section below.

Part 1: Quarter/Term/Year and Contact Information

Section A

Quarter/Term/Year:

Student Contact Information

Name:

Street Address:

City, State, Zip:

Home Phone:

Work Phone:

Cell Phone:

Fax:

E-mail:

Preceptor Contact Information

Name:

Organization:

Street Address:

City, State, Zip:

Work Phone:

Cell Phone:

Fax:

Professional/Work E-mail:

Part 2: Individualized Practicum Learning Objectives

Refer to the instructions in Week 2 to create individualized practicum learning objectives that meet the requirements for this course. These objectives should be aligned specifically to your Practicum experience. Your objectives should address your self-assessment of the skills found in the “PMHNP Clinical Skills Self-Assessment Form” you completed in Week 1.

As you develop your individualized practicum learning objective, be sure to write them using the SMART format. Use the resources found in Week 2 to guide your development. Once you review your resources, continue and complete the following. Note: Please make sure each of your objectives are connected to your self-assessment. Also, consider that you will need to demonstrate how you are advancing your knowledge in the clinical specialty.

** YOU MUST HAVE 3 NEW OBJECTIVES EACH QUARTER. You may include previous practicum objectives; however, you still must have 3 new objectives for your current course.

Objective 1: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

· (for example) Develop professional plans in advanced nursing practice for the practicum experience

· (for example) Assess advanced practice nursing skills for strengths and opportunities 

Objective 2: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

·

Objective 3: <write your objective here> ( Note : this objective should relate to a specific skill you would like to improve from your self-assessment)

Planned Activities:

Mode of Assessment: (Note: Verification will be documented in Meditrek)

PRAC Course Outcome(s) Addressed:

·

Part 3: Projected Timeline/Schedule

Estimate how many hours you expect to work on your Practicum each week. *Note: All of your hours and activities must be supervised by your Preceptor and completed onsite. Your Preceptor will approve all hours, but your activities will be approved by both your Preceptor and Instructor. Any changes to this plan must be approved.

This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.

I intend to complete the 144 or 160 Practicum hours (as applicable) according to the following timeline/schedule. I also understand that I must see at least 80 patients during my practicum experience. I understand that I may not complete my practicum hours sooner than 8 weeks. I understand I may not be in the practicum setting longer than 8 hours per day unless pre-approved by my faculty.

	Number of Clinical Hours Projected for Week (hours you are in Practicum Setting at your Field Site)	Number of Weekly Hours for Professional Development (these are not practicum hour)	Number of Weekly Hours for Practicum Coursework (these are not practicum hours)
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Total Hours (must meet the following requirements)	144 or 160 Hours

Part 4 – Signatures

Student Signature (electronic): Date:

Practicum Faculty Signature (electronic)**: Date:

** Faculty signature signifies approval of Practicum Experience Plan (PEP)

Submit your Practicum Experience Plan on or before Day 7 of Week 2 for faculty review and approval.

Once approved, you will receive a copy of the PEP for your records. You must share an approved copy with your Preceptor. The Preceptor is not required to sign this form.

© 2020 Walden University 3

,

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Content

Name: PRAC_6675_Week2_Assignment2_Rubric

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	Excellent	Good	Fair	Poor
Record the required information in each area of the Practicum Experience Plan (PEP): Part 1: Quarter/Term/Year and Contact Information: ᵒ Identify Quarter/Term/Year ᵒ Identify Student Contact Information: Name, Street Address, City, State, Zip, Home Phone, Work Phone, Cell Phone, Fax, and Walden University Email ᵒ Identify Preceptor Contact Information: Name, Organization, Street Address, City, State, Zip, Work Phone, Cell Phone, Fax, and Professional/Work Email	Points: Points Range: 5 (5%) – 5 (5%) The response accurately and clearly identifies the Quarter/Term/Year, all Student Contact Information, and all Preceptor Contact Information. Feedback:	Points: Points Range: 4 (4%) – 4 (4%) The response identifies the Quarter/Term/Year, and at least 90% of Student Contact Information and Preceptor Contact Information. Feedback:	Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) The response identifies the Quarter/Term/Year, and at least 80% of Student Contact Information and Preceptor Contact Information. Feedback:	Points: Points Range: 0 (0%) – 3 (3%) The response is inaccurate, incomplete, or is missing identification of the Quarter/Term/Year and/or identifies less than 80% of Student Contact Information and Preceptor Contact Information. Feedback:
Part 2: Individualized Practicum Learning Objectives: Explain 3 Individualized Practicum Learning Objectives that address your self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. Each Practicum Learning Objective must describe planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills you would like to improve from your self-assessment.	Points: Points Range: 69 (69%) – 75 (75%) The response clearly, accurately, and thoroughly explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. They are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused) and meet the requirements for this course. For each Learning Objective, the response clearly, accurately, and thoroughly describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Feedback:	Points: Points Range: 60 (60%) – 68 (68%) The response accurately explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response accurately describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Feedback:	Points: Points Range: 53 (53%) – 59 (59%) The response somewhat vaguely explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. They may not all be SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), or fully meet the requirements for this course. For each Learning Objective, the response somewhat vaguely describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Feedback:	Points: Points Range: 0 (0%) – 52 (52%) The response inaccurately or incompletely explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. Some or all are not SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and/or do not meet the requirements for this course. For each Learning Objective, the response has a vague, inaccurate, and/or incomplete or missing description of planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Feedback:
Part 3: Projected Timeline/Schedule: Describe your practicum timeline/schedule: ᵒ Number of weekly hours projected to work on your practicum ᵒ Number of weekly hours for professional development	Points: Points Range: 14 (14%) – 15 (15%) The response includes a clear, accurate, and thorough description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum and number of weekly hours for professional development. Feedback:	Points: Points Range: 12 (12%) – 13 (13%) The response includes an accurate description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum and number of weekly hours for professional development. Feedback:	Points: Points Range: 11 (11%) – 11 (11%) The response includes a somewhat vague description of the practicum timeline/schedule, and may be missing details about the number of weekly hours projected to work on the practicum or number of weekly hours for professional development. Feedback:	Points: Points Range: 0 (0%) – 10 (10%) The response includes a vague, incomplete, and/or inaccurate or missing description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum or number of weekly hours for professional development. Feedback:
Written Expression and Formatting—English Writing Standards: Assignment follows correct grammar, mechanics, and proper punctuation.	Points: Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Feedback:	Points: Points Range: 4 (4%) – 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors. Feedback:	Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors. Feedback:	Points: Points Range: 0 (0%) – 3 (3%) Contains ≥ 5 grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Feedback:

Show Descriptions Show Feedback

Record the required information in each area of the Practicum Experience Plan (PEP):

Part 1: Quarter/Term/Year and Contact Information:

ᵒ Identify Quarter/Term/Year

ᵒ Identify Student Contact Information:

Name, Street Address, City, State, Zip, Home Phone, Work Phone, Cell Phone, Fax, and Walden University Email

ᵒ Identify Preceptor Contact Information:

Name, Organization, Street Address, City, State, Zip, Work Phone, Cell Phone, Fax, and Professional/Work Email

— Levels of Achievement: Excellent 5 (5%) – 5 (5%) The response accurately and clearly identifies the Quarter/Term/Year, all Student Contact Information, and all Preceptor Contact Information. Good 4 (4%) – 4 (4%) The response identifies the Quarter/Term/Year, and at least 90% of Student Contact Information and Preceptor Contact Information. Fair 3.5 (3.5%) – 3.5 (3.5%) The response identifies the Quarter/Term/Year, and at least 80% of Student Contact Information and Preceptor Contact Information. Poor 0 (0%) – 3 (3%) The response is inaccurate, incomplete, or is missing identification of the Quarter/Term/Year and/or identifies less than 80% of Student Contact Information and Preceptor Contact Information. Feedback:

Part 2: Individualized Practicum Learning Objectives:

Explain 3 Individualized Practicum Learning Objectives that address your self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course.

Each Practicum Learning Objective must describe planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills you would like to improve from your self-assessment.

— Levels of Achievement: Excellent 69 (69%) – 75 (75%) The response clearly, accurately, and thoroughly explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. They are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused) and meet the requirements for this course. For each Learning Objective, the response clearly, accurately, and thoroughly describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Good 60 (60%) – 68 (68%) The response accurately explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response accurately describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Fair 53 (53%) – 59 (59%) The response somewhat vaguely explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. They may not all be SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), or fully meet the requirements for this course. For each Learning Objective, the response somewhat vaguely describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Poor 0 (0%) – 52 (52%) The response inaccurately or incompletely explains 3 Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment. Some or all are not SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and/or do not meet the requirements for this course. For each Learning Objective, the response has a vague, inaccurate, and/or incomplete or missing description of planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Feedback:

Part 3: Projected Timeline/Schedule:

Describe your practicum timeline/schedule:

ᵒ Number of weekly hours projected to work on your practicum

ᵒ Number of weekly hours for professional development

— Levels of Achievement: Excellent 14 (14%) – 15 (15%) The response includes a clear, accurate, and thorough description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum and number of weekly hours for professional development. Good 12 (12%) – 13 (13%) The response includes an accurate description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum and number of weekly hours for professional development. Fair 11 (11%) – 11 (11%) The response includes a somewhat vague description of the practicum timeline/schedule, and may be missing details about the number of weekly hours projected to work on the practicum or number of weekly hours for professional development. Poor 0 (0%) – 10 (10%) The response includes a vague, incomplete, and/or inaccurate or missing description of the practicum timeline/schedule, including number of weekly hours projected to work on the practicum or number of weekly hours for professional development. Feedback:

Written Expression and Formatting—English Writing Standards: Assignment follows correct grammar, mechanics, and proper punctuation.–

Levels of Achievement: Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Good 4 (4%) – 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors. Poor 0 (0%) – 3 (3%) Contains ≥ 5 grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Feedback:

Total Points: 100

Name: PRAC_6675_Week2_Assignment2_Rubric

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