1
Student Name: Student ID:
Section 1: Reason for implementation of the Action Plan for Professional Experience Placement (APPEP)
A. Identified Performance Issue
Student previously failed a PEP (attach Notification of Underperformance and Clinical Review Form’).
Provide details:
Student identified as requiring additional support during practical or laboratory classes. Provide
reason:
Student has failed Peer Appraisal of Clinical Skills or OSCE. Provide details:
B. Lengthy delay between Professional Experience Placements
Student has had an intermission of 12 months or more.
Last PEP Date:
Section 2: Action Plan for Professional Experience Placement (APPEP) Confirmation
Student Declaration:
I
agree
to undertake the requirements outlined in section 4 of this Action Plan for
Professional Experience Placement, within the stated timeframes.
Student Name: Signature: Date:
Academic Name: Signature:
Date:
Copy 1: Student Copy 2: Academic (saved electronically as PDF file to Student File)
Section 3: Action Plan for Professional Experience Placement (APPEP) Completion
Academic Declaration: The learning objective/s outlined in section 4 of this Action Plan for Professional
Experience
Placement have /
have not (check one) been achieved within the specified timeframes. The above
named student therefore
has /
has not completed (check one) this learning action plan.
Academic Name:
Signature:
Date:
Nursing and Midwifery
Action Plan for Professional Experience Placement (APPEP)
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signature
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signature
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2
Section 4: Action Plan for Professional Experience Placement Requirements
Clinical Review Supported Learning Plan - Nursing
List the learning objectives to be achieved by
Student Name: Student ID:
NMBA RN practice
standard
Learning Objectives: focused upon alleviating
clinical performance deficits related to the
identified under performance
Strategies to be implemented to achieve the objectives
Dates and times attended SDL
Identify learning objectives
covered during SDL
Note: Learning objectives need to be ‘SMART’ (Specific + Measurable + Achievable + Realistic + Timely)
3
Section 4: Action Plan for Professional Experience Placement Requirements
Clinical Review Supported Learning Plan - Midwifery
List the learning objectives to be achieved by
Student Name: Student ID:
NMBA midwife
practice standard
Learning Objectives: focused upon alleviating
clinical performance deficits related to the
identified under performance
Strategies to be implemented to achieve the objectives
Dates and times attended SDL
Identify learning objectives
covered during SDL
Note: Learning objectives need to be ‘SMART’ (Specific + Measurable + Achievable + Realistic + Timely)
4
Administration
NOTE: Printed copies of this document are uncontrolled, and currency can only be assured at the time of printing.
Approval Details
Nursing and Midwifery Learning and Teaching Committee
19-1
18/07/2022
Revision Histor
y
Version
Approval
date
Implementation
date
Details
Author
19-1
Action plan to improve
preparedness for students on
Professional Experience Placement
Academic Lead: Professional Placement
18/07/2019 18/07/2019
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