Bon Secours Memorial College of Nursing

NUR 4215P Vulnerable Populations Practicum

Mentor Agreement

Student Name: Kelley Schlosshan

Practicum Site: RAM Mission Trip- Buena Vista, Virginia March 9-11, 2018

Prior to placement of the student in a specific clinical environment, the post-licensure

coordinator and course faculty ensure that the practicum site is an effective learning
environment that will allow students to demonstrate the required competencies of the post-
licensure nursing program.

I. Purpose: To provide students with opportunities to enhance practicum learning experiences

while practicing under the guidance of a mentor.

II. Role and Responsibilities of Mentor:

1. Serves as a resource to student and mentor for the duration of the practicum.
2. Is available to mentor and student by phone or e-mail as needed.
3. Assists students in establishing appropriate objectives for practicum, based on opportunities
in the practicum setting, student strengths and deficits, and general program objectives.
4. Overall responsibility for facilitating student experience in order to meet the course
objectives.
5. Informs practicum faculty of student progress as well as issues and concerns related to
student performance.
6. Contributes to student evaluation.

III. Role and Responsibilities of Practicum Faculty

1. Serves as a resource to student and mentor
2. Is available to mentor and student by phone or e-mail as needed.
3. Assists students in establishing appropriate objectives for practicum, based on opportunities
in the practicum setting, student strengths and deficits, and general program objectives.
4. Contacts the mentor 2 to 3 times during the practicum as mutually negotiated or arrange a
visit if necessary to make sure the practicum is progressing as planned and the student is
focused on the practicum and personal objectives.
5. Assumes primary responsibility for problem solving student issues.
6. Overall responsibility for ensuring that students meet the course objectives.
7. Assigns final course grades.
8. Contributes to mentor evaluation, including reviewing student evaluations of mentor.
9. Gives verbal feedback to the student as appropriate throughout the practicum experience.
Any concerns about the student performance should be communicated with the student.
10. Completes a written evaluation of student performance at midterm (if needed) and at the
end of the semester that includes anecdotal feedback.

IV. Role and Responsibilities of Student

1. Establishes individual objectives and uses course objectives as a guide.
2. Appropriately identifies own areas of strength and deficits.
3. Collaborates with faculty and mentor as needed in setting objectives.

NUR 4215P Mentor Agreement 2015

 Bon Secours Memorial College of Nursing
NUR 4215P Vulnerable Populations Practicum
Mentor Agreement

4. Contacts mentor to determine a schedule for completing the required hours for the
practicum experience.
5. Schedules 40 practicum hours in collaboration with the practicum site.
6. Informs practicum faculty of the schedule.
7. Informs mentor and practicum faculty of any change to the schedule.
8. Participates in phone conferences as needed
9. Utilizes practicum faculty and mentor appropriately
10. Abides by ANA code of ethics and standards of practice at all times.
11. Maintains self in student role vs. RN provider of care.
12. Seeks guidance when needed.
13. Acknowledges deficits and responds to feedback
14. Participates in evaluation processes
15. Evaluates self using reflective practice.
16. Provides feedback to the mentor, practicum learning site, and faculty
17. Complies with site policies and regulations

By signing below, I understand and agree to perform the role and responsibilities as outlined above for
the mentored practicum experience with the student named above.

Mentor Printed Name: ________________________ Date: ______________________

Current role _________________________________

Mentor Signature: ____________________________

Faculty Signature: _M.Sangha RN,MSN,MBA___________________________

Post-Licensure Coordinator Signature: __Laura A. Vasel RN,MSN, CPNP, CNE__

NUR 4215P Mentor Agreement 2015