13 Revised 6/15/20
Practical Nursing Admissions Application
Nursing Essential Skills and Functional Abilities
The Practical Nursing Program is a discipline with cognitive, sensory, affective and psychomotor performance requirements. Based on these
requirements, the following list highlights the Nursing Essential Skills and Functional Abilities that have been developed. Each standard has
an example of activities which a student will be required to perform, with or without an accommodation, while enrolled in the PN program
at Manhattan Tech. The Nursing Essential Skills and Functional Abilities should be used as a guide to assist applicants in determining
whether or not accommodations or modifications are necessary in order to meet program participation requirements. Applicants who
identify potential difficulties with meeting the Program Performance Standards should communicate their concerns to the Director of
Nursing. If the concern is related to a documented disability, applicants are responsible for contacting the Student Retention
Specialist. Determination of reasonable and appropriate accommodation will be made on an individual basis in consultation with the
Student Retention Specialist. Additionally, applicants should assess their aptitude and ability to perform professional duties by reviewing the
Program Performance Standards below and discussing them with their healthcare provider.
Critical Thinking
Critical thinking sufficient for clinical
Competent assessment of patient in timely
manner; correct interpretation of assessment;
readily respond with appropriate treatment plans;
ability to work alone and to make correct
independent decisions as needed.
Interpersonal abilities sufficient to
interact with individuals, families and
groups from a variety of social,
emotional, cultural, and intellectual
Life and death situations; working with families
stressed by the condition of a loved one; working
with other healthcare providers in stressful
Communication abilities sufficient for
interaction with others in verbal and
written form.
Ability to follow verbal and/or written instructions.
Must communicate patient response to therapy
with others; document therapeutic procedures
performed on patient; consult with other
healthcare providers in a professional manner.
Physical abilities sufficient to move
from room to room and walk in
hallways; maneuver in small spaces.
Includes the strength necessary to lift
patients as needed.
Walking to and from departments to patient
rooms; walking room to room to take care of all
patients on a team; assisting in patient transport.
Tactile and
Motor Skills
Gross and fine motor abilities
sufficient to safely and effectively
perform nursing care. Tactile ability
sufficient for physical assessment and
to provide nursing intervention.
Perform vital signs, CPR, transporting patients,
physical assessment, manipulating equipment.
Perform palpation; give injections; intravenous
initiation; provide sterile and non-sterile dressing
changes; urinary catherizations; assist patient with
daily activities.
Auditory ability sufficient to monitor
and assess health needs.
Auscultation of BP, breath sounds, heart sounds,
bowel sounds; hearing alarms in units, call bells,
telephones, and conversing with patients, family,
and staff.
Visual ability sufficient for observation
and assessment.
Reading patient charts/flow sheet/monitors;
drawing up and administering medications;
assessing patient skin color; reading thermometers.
13 Revised 6/15/20
Practical Nursing Admissions Application
Health Care Provider Signature Form
Instructions for completion of Health Care Provider Signature Form:
A health care provider must sign the Health Care Provider Signature Form between March 1, 2019-March 1, 2020 and indicate
whether the applicant will be able to function as a nursing student. Health care providers who qualify to sign this declaration include a
licensed physician (M.D., D.O.), a nurse practitioner, or physician’s assistant.
(Please Print)
Applicant Name: Student ID Number:
It is essential that nursing students be able to perform a number of physical activities in the clinical portion of the program. At a minimum,
students will be required to lift patients, stand for several hours at a time and perform bending activities. Additionally, nursing students
must be able to sit for long periods of time in a classroom environment. Students who have a chronic illness or condition must be
maintained on current treatment and be able to implement direct patient care. The clinical nursing experience also places students under
considerable mental and emotional stress as they undertake responsibilities and duties impacting patients’ lives. Students must be able to
demonstrate rational and appropriate behavior under stressful conditions. Individuals should consider the mental and physical demands of
the program prior to submitting application.
I have reviewed the Manhattan Tech Nursing Essential Skills and Functional Abilities. I believe the applicant:
WILL WILL NOT be able to function as a nursing student as described above.
If not, explain:
Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.):
Print Name: Title:
Signature: Date:
Zip Code:
Phone Number:
This form will need to be completed and uploaded at time of submitting the online PN application.
click to sign
click to edit