REENTRY INFORMATION AND APPLICATION

TRINITAS SCHOOL OF NURSING

IMPORTANT INFORMATION REGARDING ELIGIBILITY FOR RE-ENTRY

Re-Entry into a NURE course refers to those students who exit the Nursing program and have not maintained matriculation in the sequence of NURE courses.

Examples include students who:

1. withdraw from an NURE course

2. have only one NURE course failure

3. successfully pass an NURE course and do not enter into the next NURE course.

Students requesting Re-Entry must obtain and complete and submit the Re-Entry Application.  A minimum GPA of 2.75 is required to submit a reentry application.

There is no guarantee of Re-Entry into the Nursing Program. Re-Entry decisions are based upon GPA and a number of other factors including but not limited to number of seats available; number of previous course withdrawals; number of Clinical Warnings; and presence and nature of any Critical Event reports. Time out of the nursing sequence will also be considered.

The decision regarding a student’s re-entry into the Nursing program is final.

SCHOOL OF NURSING                               DATE RECEIVED 

 RE-ENTRY APPLICATION

Signature: __________________________________________Date ____________________

A Completed Re-Entry Application can be submitted:

• Electronically as an email attachment
• The student must use his/her UCC email address
• A non-UCC email address will not be accepted
• Submit by email to fioretti@ucc.edu or kelley@ucc.edu 
• A paper version may be submitted to the Trinitas School of Nursing Office, Room 505.

Online Registration for Trinitas School of Nursing Students

Please note that effective with the Spring 2009 semester Trinitas School of Nursing students may now register for general education courses online. Registration for nursing (NURE) courses continues to be held in person by school personnel; therefore, you may not register for any nursing course online. If you are interested in registering online, please visit www.ucc.edu and click on

e-services. Please ensure that all financial obligations are cleared before using e-services to register. Payment is due at time of registration. E-services is available Monday through Friday from 8:30am until 10:00pm and on Saturday from 9:00am until 12 noon.

TRINITAS SCHOOL OF NURSING

EXPLANATION OF REGISTRATION CHECKLIST

1. Health Clearance- The complete health form has been submitted by the student and reviewed by the Coordinator of Student Health. Health forms submitted on the day of registration may not be reviewed in time for registration. For additional information, see the sheet called “health Clearance”. Health form can be found in the school website, www.ucc.edu/go/trinitas, click on Nursing Program forms.
2. Criminal background report must be on file with the School of Nursing. A student with a record of felony or misdemeanor will not be allowed to register. The form to apply for criminal background check is on the school website, www.ucc.edu/go/trinitas, click on Nursing Program forms.
3. CPR for Health Care Provider from the American Heart Association. CPR from the Red Cross or other entity will not be accepted. This card must cover the time up to or beyond June 1, 2009. Show the card at the time of registration. If the card has not been issued yet, you may bring the letter from the CPR instructor that states that you passed the CPR course. The letter must bear the letterhead of the agency that provided the course.
4. Mandatory Education for Trinitas Hospital. This is required every semester and can be done on-line. The student must print and show a copy of the sheet indicating that he/she has successfully passed the post-test. Direction to take the mandatory education and post test is attached.
5. Malpractice insurance for RN student. The policy must cover a minimum of three (3) million dollars and must cover the period up to or beyond June 1, 2009. The student must show the actual policy at registration. The receipt for payment to the insurance company will not be accepted in lieu of the actual policy. You may contact NSO at 1-800-247-1500, www.nso.com or Marsh at 1-800-503-9230, https://www.proliability.com. Check nursing publications for other companies.
6. Drug Screening at Trinitas Hospital Occupational Health Dept. The cost for the screening is $60.00 and must be paid by the student. The student will call 908-994-5368 to make an appointment for the screening. The report will be sent directly to Dean Kelley and will be on file at the School of Nursing.
7. Consent for Video Recording for Clinical Simulations. This is required since all clinical courses participate in clinical simulation as part of the course.
8. Document from UCC Office of Disability for reasonable accommodation. This request will be reviewed by the School administration. The student will be informed if the request can be accommodated prior to course registration. Request for accommodation related to a pre-existing condition after the course has started may not be granted.
9. Request for Absence of more than one clinical day/evening weekend. A written, signed statement from the student requesting the absence will be submitted to the Dean prior to registration. The student will indicate the exact dates of absence being requested. The School administration will review the request. The student will be informed of the options prior to course registration.
10. The student will sign and date the Registration Checklist. By signing, the student certifies that he/she completed the pre-requisite courses for the NURE course and has completed or will complete the co-requisite courses this semester.
11. If the student provides false information, he or she will not be allowed to remain in the course or to register for future NURE courses.

Directions to complete Mandatory Education On-line

Trinitas Hospital requires that all students and instructors complete the mandatory education for the hospital. This is to be done on-line.

Directions:

a. log on to www.trinitashospital.org

b. Click on Department/Services

c. Click on Employee Education Department

d. Click on Mandatory Program

e. Type in password bwinkle

f. User name and password – don’t fill anything in – just hit create new account

g. Next screen – complete all fields (if password does not work on first try, use another)

h. Read the material

i. Take the test. Type your name and your unit is School of Nursing

j. Click submit when done

k. Print the certificate of completion for your record.

TRINITAS SCHOOL OF NURSING

REGISTRATION CHECK-LIST

Name: _____________________________________ Course ________________

Instruction:

• All requirements must be completed (items signed off by Trinitas School of Nursing authorized personnel) before you are allowed to register.
• Present this completed sheet at registration.
• If you provide false information, you will not be allowed to remain in this course or to register for future NURE courses.

1. Health Clearance _________________________________________

2. Criminal Background Check __________________________________________

3. CPR (AHA) & Expiration Date __________________________________________

4. Mandatory Education (Trinitas) & Date ____________________________________

5. Malpractice Insurance (Student RN) & expiration date________________________

6. Drug Screening ______________________________________________________

7. Consent for Video Recording for Clinical Simulations ________________________

8. Document from UCC Office of Disability, Request for Accommodation___________

9. Request for Absence of more than one clinical day/evening/weekend _____________

Note:

Students who register for this NURE course without the pre-requisite and co-requisite courses will not be allowed to register for future NURE courses.

I certify that I have successfully completed the pre-requisite courses for this NURE course and have completed or will complete the co-requisite courses this semester.

I agree to allow the Trinitas School of Nursing to save a copy of the video/audio recording of my clinical simulations. This video/audio will be used as a learning tool for other students and/or instructors. It will be permanently deleted when it is no longer used as a learning/learning tool.

Student Signature/ Date School Representative/ Date

1/8/08;5/5/08;8/10/08

TRINITAS SCHOOL OF NURSING

PROCEDURE FOR COURSE REGISTRATION

To: All students registering for NURE courses (except NURE 130)

From: Dean M. Kelley

Date: October 10, 2008

Subject: Spring 2009 Registration

1. The dates and place for registration for individual NURE courses will be posted on the School website and announced through the WebCT or Angel learning management system.
2. On the day of registration, admission tickets will be distributed from the School of Nursing Office (Room 505) at 8:30 AM on a first come, first serve basis.
3. Students must fill in all information on the course registration form except the course number and section. The code (Major) for Trinitas School of Nursing is EGHN.
4. Registration will begin promptly at the time scheduled.
5. The student must be present when his/her number is called or will be moved to the end of the line.
6. Students must present a registration checklist signed by authorized school personnel indicating that they have fulfilled the following requirements:
• Completed health form
• Criminal background check
• Current CPR for Health Care Provider (American Heart Association)
• Trinitas Hospital Mandatory training
• Malpractice insurance for Student RN
• Drug Screening
• Document from UCC Office of Disability (if applicable)
• Request for Absence of more than one clinical day/eve/weekend (if applicable)
7. Only students with completed & signed registration checklists will be allowed to register.
8. If a student does not have the requirements at the time of registration, the student cannot register. He or She will register on the date posted for re-entry students.
9. A student who causes a disorder in the registration process will be asked to leave. There will be zero tolerance for misconduct on school premises.

Spring 2009

Registration Dates

January 6, 2009 (T):

9 AM to 1 PM- NURE 131

2-4 PM- NURE 231

January 7, 2009 (W):

9 AM to 1 PM- NURE 132

1-3 PM- NURE 232 and NURE 250

January 9, 2009 (F)

NURE 130- registration is by invitation only.

Students who did not have their clearances completed will register with the re-entry students (see dates below).

January 12, 2009 (M): Re-entry

10 AM-1 PM- NURE 131

2- 4 PM- NURE 232

January 13, 2009 (T): Re-entry

10 AM-1 PM- NURE 132

2-4 PM- NURE 231 and NURE 250

January 22, 2009- Classes start

Trinitas School of Nursing Health Clearance Information

Students are required to have health clearance before they are allowed to register for NURE 131 and higher courses.

All NURE 132, NURE 231, NURE 232, and LPN to RN students:

• Mantoux test (TB) must be repeated yearly. To be allowed to register for your course, your TB test must have been completed after June 1, 2008. Send the result to P. Stansfield. You must have your name and the NURE course on this report.
• If you had a past positive TB test, you do not have to do the TB test nor do you need to repeat your chest x-ray.
• If you received a MMR (Measles, Mumps, Rubella) vaccine in the Fall 2008 semester, you must repeat the blood titer for the disease that you were not immune to. This will show whether you have built immunity to the vaccine that you received. Submit this titer or titers to P. Stansfield by December 1, 2008.
• *NEW* Drug screening at Trinitas Hospital Occupational Health Department, 1^st floor Administrative Services Bldg., Trinitas Hospital, 225 Williamson St., Elizabeth, NJ. Call for appointment (908-994-5368). The fee is $60.00.
• Flu vaccine or signed waiver form.

All NURE 130 students who plan to register for NURE 131.

• Download all pages of the health form from the school website, www.ucc.edu/go/trinitas. Click on Nursing Program Forms, then Student Health Packet.
• Be sure that your name, address, student ID number and phone number are legible on the form.
• The physical exam form must be completed by your doctor or health care provider.
• Ask your doctor or your health care provider to review all lab results with you including: MMR (Measles, Mumps, Rubella) titer, Varicella (chicken pox) titer, and Hepatitis B. If you are not immune to these diseases, you must take the vaccine accordingly. Follow-up titers would be done three months after the administration of the vaccine.
• Test for Hepatitis B. If you are not immune to Hepatitis B, you may sign the Hepatitis B waiver form (in your health packet) if you do not wish to have the vaccine.
• You must have a Mantoux test (TB) done after June 1, 2008. An earlier report will not be accepted for the spring 2009 registration. Mantoux test is required yearly. If you had a positive Mantoux test, a chest x-ray report in the past year will be accepted.
• *NEW* Drug screening at Trinitas Hospital Occupational Health Department, 1^st floor Administrative Services Bldg., Trinitas Hospital, 225 Williamson St., Elizabeth, NJ. Call for appointment (908-994-5368). The fee is $60.00.
• Flu vaccine or signed waiver form.

Note to all: Make a copy of all your health forms for your records.

Submit all original forms to Patricia Stansfield, RN, Health Coordinator, by November 1, 2008. In her absence, you may submit your packet to the School of Nursing Office in Room 505. Mrs. Stansfield’s office hours are on Tuesdays, from 4-10 PM in Room 512. Her phone number is 908-659-5148. Her email address is stansfield@ucc.edu.

TRINITAS SCHOOL OF NURSING

STUDENT HEALTH RECORD

Please complete this form to the best of your ability and bring it to your Physician,

Nurse Practitioner, Physician Assistant for your physical examination.

Make a copy of your completed Health Record and submit the copy to our Health Nurse,

Mrs. Stansfield, or the School Administrative office Room 505.

RETURN TO:

Mrs. Patricia Stansfield

Trinitas School of Nursing

12 West Jersey Street

Elizabeth, New Jersey 07202

908.659.5148

stansfield@ucc.edu

TRINITAS SCHOOL OF NURSING

STUDENT HEALTH RECORD

Name (Last) (First) Middle Initial

Fall Semester Spring Semester CWID#

Course: NURE Section: Day Evening Weekend

Birth Date Male Female

Address

City State Zip Code

Home Phone# Cell # Work #

STUDENT: Please check all items that apply to you:

Allergies High blood pressure

Asthma Migraine or severe headaches

Arthritis or Rheumatism Hepatitis

Back Injuries Bronchitis or Chronic cough

Chest pains Psychiatric disorder

Chronic back pain Heart disease

Convulsions Tuberculosis

Diabetes Surgery

Dizzy spells or fainting Epilepsy

Hearing problems Any other serious illness

State details for all items check above:

List present medications:

I certify that to my knowledge I have had no injury, illness or ailment other than specified and permit the examining Health Care Provider to submit a medical report including test results to Trinitas School of Nursing.

Signature Date

TRINITAS SCHOOL OF NURSING

STUDENT HEALTH RECORD

TO BE COMPLETED BY PHYSICIAN/NURSE PRACTITIONER/PHYSICIAN ASSISANT

Weight Height Pulse Resp. B/P

PHYSICAL FINDINGS

General Appearance
Skin
Hair
Eyes	Visual Acuity: Without Correction, Right Left With Correction, Right Left
Ears	Hearing Acuity: Right Left
Nose
Mouth
Throat/Neck
Respiratory
Cardiovascular
Breasts/Axilla
Abdomen/Hernia
Genitalia
Musculoskeletal
Neurological
Psychological
Endocrine
Lymph Nodes
Hematological

Flu Vaccine Date: Waiver form attached and signed:

Mantoux Date: Results: mm Interpretation ( ) Negative ( ) Positive

If Positive: Date Chest X-Ray Chest X-Ray Result

Treatment

I have examined (student) and found no indication of any disease or condition which might affect the health and safety of the student or the health and safety of the clients whom the student may provide care to. This student is able to fully participate in the clinical rotation.

Signature: Date:

(Health Care Provider)

Name (PLEASE PRINT)

Address City State

Phone # Fax

MD/NP/PA STAMP:

TRINITAS SCHOOL OF NURSING

WAIVER

FOR FLU VACCINATION

I am requesting that Trinitas School of Nursing waive the

health requirements for the FLU VACCINATION and I

have signed this declination below.

Signature Date

TRINITAS SCHOOL OF NURSING

STUDENT HEALTH RECORD

TO BE COMPLETED BY HEALTH CARE PROVIDER

A COPY OF THE ACTUAL LABORATORY TITER RESULT MUST BE SUBMITTED WITH THIS FORM

Rubeola Titer { } Immune

{ } Non-Immune: Vaccine required Date Given

Mumps Titer { } Immune

{ } Non-Immune: Vaccine required Date Given

Rubella Titer { } Immune

{ } Non-Immune: Vaccine required Date Given

Varicella Titer { } Immune

{ } Non-Immune: Vaccine required Date Given

HBsAb Titer { } Negative: If Negative Vaccination Recommended or Declination signed

{ } Positive

HBsAg Titer { } Negative

{ } Positive: If Positive MD Counseled and Cleared Date

If Hepatitis B Vaccine Series is/has been given list: Date # 1

Date #2

Date #3

Signature Date (Health Care Provider)

Hepatitis B Virus Vaccine Declination

Due to personal, medical or religious reasons, I am requesting that TRINITAS SCHOOL OF NURSING

Waive the health requirement for immunization against Hepatitis B. I am aware of the health risks

of this disease, the mode of transmission, and possibility of exposure to Hepatitis B to health care

professionals.

Student Signature Date

Directions for Drug Screen

Call Trinitas Hospital Occupational Health Department (908-994-5368) for an appointment. On the day of the screening, bring this completed form and $60.00 to the Trinitas Hospital Occupational Health Department in the Administrative Building, first floor. The result will be sent to Trinitas School of Nursing.

DRUG SCREENING TEST CONSENT

Trinitas Hospital and Trinitas School of Nursing maintain a drug free environment.

Therefore, as part of pre-clinical physical examination to insure that I am physically able to perform the clinical component of my program, I am required to provide a urine sample for testing to determine my status for illegal drug use.

Students with a positive drug screen use and/or unadulterated drug screen for illegal drug will not be allowed into or remain in the nursing program of Trinitas School of Nursing.

I, ___________________________________, consent to providing a sample of my urine to be tested for drug content.

If I refuse to sign the consent or refuse to provide a sample for drug screening, I understand that the health clearance will not be completed satisfactorily and I will not be allowed in the clinical course at this time.

I understand that I will be informed of the results of this tests and that appropriate action will be taken, consistent with the policy of Trinitas School of Nursing.

I understand that a positive illegal drug screen and/or an adulterated drug screen will be reported to the Dean of Trinitas School of Nursing for appropriate action, consistent with the policy of Trinitas School of Nursing.

Student Signature______________________________________________

Date ___________________________________

Did you have breakfast today? ( ) Yes ( ) No

Please list any and all medications currently being taken:

________________________ __________________________

_______________________ __________________________

_______________________ __________________________

________________________ __________________________

8/14/08