Practicum Experience Plan Overview: Your Practicum experien

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

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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.
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)

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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
Number of
Weekly Hours
for
Professional
Development
Number of
Weekly Hours
for Practicum
Coursework
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:

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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