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*2. |
PPS/Badge #:(ex: UC000111999) |
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*5. |
Department manager/supervisor |
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Section Instructions: |
Provide information concerning your upcoming observational experience. If you do not know Preceptor's name, leave blank. |
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*6. |
Expected Date(s) of observation |
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*7. |
Observational Unit/Department Manager |
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*8. |
Observational Unit/Department: |
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Personal Objectives/Goals |
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Section Instructions: |
What do you wish to learn, contrast, evaluate, identify during this experience? What will you do to achieve your goals? Discuss with your mentor and or nursing manager of visiting unit. |
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*10. |
Personal Learning Objectives/Goals: |
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Section Instructions: |
Professional Leave is granted through your manager, but CPPN would like to know if: |
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*11. |
Have you requested to use Professional Leave for your Bridges to Excellence experience? |
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12. |
Has your Professional Leave Time request been approved by your manager? |
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