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Northern Collaborative Baccalaureate Nursing Program

Surgical Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Medical Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Gerontology Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Maternity Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Pediatric Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Mental Health Experiences

Course Date Diagnosis Acuity Age Gender Additional


Primary & Secondary Experiences/Comments
Northern Collaborative Baccalaureate Nursing Program

Community Experiences

Date Diagnosis Age Gender Additional Experiences/Comments


Primary & Secondary
Northern Collaborative Baccalaureate Nursing Program

Clinical Course Summary of Patient Experiences (to be used for each clinical course):
NURS_________
Please add reflective work to this document before bringing it to your final evaluation (e.g.
Journaling, reflective assignments, etc.)

Date Diagnosis Acuity Age Gender Additional Experiences/Comments


Primary & Secondary

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