Please Provide Your Full Names Rather Than Initials
Professional Experience Placement (PEP) Support Form:
Aged Care Child & Family Health Mental Health
For South Australian students only
Please type information into form as far as possible and then print out for signatures.
In order to plan for your Professional Experience Placement (PEP) the School of Nursing & Midwifery requires details of your proposed placement(s) and venue(s).
1.Your Details
Please provide your full names rather than initials
Flinders Student ID:(if applicable) / Title:
(Mr, Mrs, Ms, Dr)
Family Name: / Given Name(s):
Home Telephone Number:
(include area code) / ( ) / Mobile Number:
Email Address:
Mailing Address:
2. Your Program of Study
I have been admitted into(please tick)☐Graduate Certificate or ☐Graduate Diploma or ☐Masters in the following specialisation:
☐AGED CARE
Placement requirements:
NURS8707 Nursing Care of Older People with Complex Health Needs (PEP) (offered in Semester One) - 10 days clinical placement.
☐CHILD AND FAMILY HEALTH
Placement requirements:
All courses
- NURS8823 Clinical Practice for Child and Family Health Nursing (offered in Semester Two) – 160 hours over one semester which equates to 20 days and is normally undertaken two days per week. This placement must include the following requirements:
- 3 days residential family centre services
- ½ day contact centre services (telephone service)
- ½ day hearing assessment centre
- ½ day child development unit (hospital or community based)
- 15 days should be undertaken in early childhood placements
Possible options for placements include: child health centres (0-5/12yrs); residential family centres services; state/council health services/home visiting; breastfeeding clinics/day services; hearing assessment clinics; contact centre services (24 hour telephone counselling) and youth health services/school health services.
Graduate Diploma and Masters ONLY
- NURS8826 Advanced Clinical Practice for Child and Family Health Nursing (offered in Semester One) – You will develop your own learning plan through which you will explore an area of extended practice. You will need to negotiate your own clinical field placement(s) of approximately 60 hours.
☐MENTAL HEALTH
Placement requirements:
All courses
- *NURS8761 Acute Mental Health Nursing Practice (PEP) (offered in Semester One) - 200 hours in an acute inpatient mental health setting. Your placement must take place in a specified seven (7) week period within semester one within which you can negotiate your preferred hours / days. This placement period usually runs from May to June.
Graduate Diploma and Masters ONLY
- *NURS9542 Counselling in Mental Health Nursing Practice (PEP) (offered in Semester Two) - 200 hours in a community / counselling mental health setting. Your placement must take place in a specified seven (7) week period within semester two within which you can negotiate your preferred hours / days. This placement period usually runs from September to October.
*Placements for these topics cannot be undertaken at the same venue unless the venue can provide both
acute and community settings.
Please see relevant Study Plans to assist with topic selection.
3. Your Professional Experience Placement (PEP) Types
Please tick theplacement types that you require:
You are already employed in the area of specialisation you are studying and you will be able to undertake a Work Integrated Learning placement with your employer for these topic(s): / You are not employed in the area of specialisationand you need the School’s PEP Unit to negotiate a placement for these topic(s):Aged Care / NURS8707 Nursing Care of Older people with Complex Health Needs (PEP) / ☐ / ☐ /
Mental Health Nursing / NURS8761 Acute Mental Health Nursing Practice (PEP) / ☐ / ☐ /
NURS9542 Counselling in Mental Health Nursing Practice (PEP) / ☐ / ☐ /
Are you employed on the SA Health Graduate Mental Health Nursing Program? ☐Yes ☐No
Child & Family Health Nursing / NURS8720 Primary Health Care (Constructs and Contexts) / ☐ / ☐ /
NURS8823 Clinical Practice for Child and Family Health Nursing / ☐ / ☐ /
NURS8826 Advanced Clinical Practice for Child and Family Health Nursing / ☐ / ☐
For this topic you need to negotiate your own placement with a suitable venue.
- Employer/Clinical Venue Support
If you are negotiating your own placement or undertaking it in your workplace, it is essential that you can show evidence that your Clinical Manager or proposed host venue manager will support your completion of the PEP components of the course. You may undertake your placement in more than one venue if necessary. Please note that it is essential that this section be signed by your employer or host venue/clinical manager before you submit this form.
Venue 1: To be completed by your Clinical Manager/host venue manager:
As Clinical Manager/host venue manager, please complete the section below as evidence that your venue will support the completion of the clinical practice components of the course for this applicant.
Please provide full names rather than initials.
Clinical Manager’s Name & Title:Clinical Manager’s Role:
Clinical Manager’s Phone Number:
(include area code) / ( ) / Clinical Manager Email:
Ward/Region/Team of Employment:
Organisation’s Name in full:
Is student employed at this venue? / ☐Yes ☐No
Organisation’s Street Address:
Organisation’s Mailing Address:
(if different to above)
ABN (Private organisation only):
Proposed placement dates:
For NURS8823 Clinical Practice for Child and Family Health Nursing only – please tick placements being provided at your venue: / ☐3 days residential family centre services
☐½ day contact centre services (telephone service)
☐½ day hearing assessment centre
☐½ day child development assessment service (hospital or community based)
☐15 days should be undertaken in early childhood placements
I agree that the required support will be provided to the applicant to undertake the professional experience placement components of the course within this workplace (please tick):
☐Provide the required number of placement hours in the designated nursing environment
☐Allocate or assist with the choice of preceptor(s) in the clinical area
☐Supervision in and assistance with acquisition of clinical skills
☐Provide guaranteed support for the entirety of the agreed placement duration
Clinical Manager’s Signature:(or equivalent) / Date:
Director of Nursing or Designated Proxy: / Date:
Venue 2: To be completed by your Clinical Manager/host venue manager:
As Clinical Manager/host venue manager, please complete the section below as evidence that your venue will support the completion of the clinical practice components of the course for this applicant.
Please provide full names rather than initials.
Clinical Manager’s Name & Title:Clinical Manager’s Role:
Clinical Manager’s Phone Number:
(include area code) / ( ) / Clinical Manager Email:
Ward/Region/Team of Employment:
Organisation’s Name in full:
Is student employed at this venue? / ☐Yes ☐No
Organisation’s Street Address:
Organisation’s Mailing Address:
(if different to above)
ABN (Private organisation only):
Proposed placement dates:
For NURS8823 Clinical Practice for Child and Family Health Nursing only – please tick placements being provided at your venue: / ☐3 days residential family centre services
☐½ day contact centre services (telephone service)
☐½ day hearing assessment centre
☐½ day child development assessment service (hospital or community based)
☐15 days should be undertaken in early childhood placements
I agree that the required support will be provided to the applicant to undertake the professional experience placement components of the course within this workplace (please tick):
☐Provide the required number of placement hours in the designated nursing environment
☐Allocate or assist with the choice of preceptor(s) in the clinical area
☐Supervision in and assistance with acquisition of clinical skills
☐Provide guaranteed support for the entirety of the agreed placement duration
Clinical Manager’s Signature:(or equivalent) / Date:
Director of Nursing or Designated Proxy: / Date:
If you have extra venues, please copy and paste the above section.
- Preceptor Details
The School requires thedetails of at least one preceptor who willsupport your placement(s) for every venue. If you do not yet have this information you can still submit this form. When you have organised your preceptor(s), please use the ‘Confirmation of Ongoing Support Form’ to notify us of your nominated preceptor(s) details. This must be done prior to the commencement of your placement.
☐ I do not currently have preceptor information and will supply this information using the ‘Confirmation of Ongoing Support form’ when the information is available.
Preceptor 1 – please provide full name rather than initials
Name and Title:Position and Role Title:
Service / Department:
Organisation in full:
Qualifications:
Telephone:
(include area code) / ( ) / Mobile:
Email:
Topic:
Preceptor 2 - please provide full name rather than initials
Name and Title:Position and Role Title:
Service / Department:
Organisation in full:
Qualifications:
Telephone:
(include area code) / ( ) / Mobile:
Email:
Topic:
In addition to your preceptor, the School of Nursing and Midwifery will provide a PEP facilitator who will contact you within the first two weeks of your placement. The PEP facilitator will link the topic’s theory and practice from a university perspective and will support both you and your preceptor(s).
6. Important Additional Requirements
It is essential that the following arrangements are in place before you commence your placement even if the placement is within your own workplace:
- An Affiliation Agreement between your host venue and the University must be in place before you can commence your placement even if your host venue is also your employer. If an agreement is not in place it can take up to eight weeks for this legal process to be completed. The University undertakes this process for you and we ask that you submit this form as soon as possible to ensure that we can conduct these negotiations before you are due to commence your placement(s). The University will advise you if you need to delay your placement whilst an Affiliation Agreement is negotiated and advise you when you are able to commence your placement once it is in place.
- The Professional Experience Placement Unit must receive evidence that you comply with all the Pre-placement Requirements as outlined on the Student Responsibilities page of the Postgraduate PEP website before a placement can be undertaken. Please refer to:
7. Applicant’s Declaration
- I agree that the School of Nursing & Midwifery may contact the venues/host venue I have detailed here, if there are questions regarding the placements I have nominated.
- I consent to the School of Nursing & Midwifery providing my nominated preceptors with my contact details prior to the commencement of my placement.
- I acknowledge that if I fail to provide all required documentation in a timely manner prior to my placement I may be required to withdraw from the topic. If this occurs beyond the census date for the topic(s), then penalties (including financial costs for the topic) will be incurred by me.
- If I decide to withdraw from my topic enrolment(s), I will do so via the Student Information System prior to the census date for the topic(s).
- I have read and understood Section6. Important Additional Requirements and accept the School of NursingMidwifery’s pre-placement requirements.
Applicant’s Signature: / Date:
8. Submitting This Form
Scan and email the completed form . A return email will confirm satisfactory receipt of your documentation.
It is recommended that you retain a copy of the completed document for your records.
PEP Support Form: Aged Care, Child and Family Health, Mental Health (SA Students) (Version5.0)Page1 of 5