Memo 44: Coursework in Clinical Settings Abroad

By approval of Deans & Chairs and due to the following considerations, nursing students seeking to undertake activities as UW students in clinical settings internationally must comply with this policy.

Types of activities

Proposals to pursue student activities in clinical settings abroad fall into three categories: observational, educational, or hands-on provision of care. Observational activities include courses or exploration seminars where there is no project or assessment. Educational activities include needs assessments, quality improvement, teaching, or similar capstone practice activity. Hands-on care involves the delivery of clinical care under a scope of practice with appropriate supervision. Coursework may be approved as study abroad, independent study, practicum, or capstone credits. PhD dissertation work is not addressed by this memo and is governed by a student’s doctoral committee.

Criteria for approval of proposals to complete coursework in clinical settings abroad

Approved projects will address the traits of the student, faculty sponsor, and clinical setting required for an effective learning experience that meets course objectives. Criteria include:

RELATIONSHIP: The supervising faculty member has significant expertise and relationship with the specific international site. Appropriate institutional agreements are in place (see required agreements below).
PREPARATION: The student has significant and adequate contextual preparation for the setting, including language as necessary, and is a student in good standing.
STANCE: The student demonstrates how they will maintain a stance as a learner and possesses an ability to accept feedback and adapt behavior accordingly.
CAPACITY: The site has the wherewithal and desire to integrate the student as an observer or volunteer.
LIMITS: The student, faculty sponsor, and site agree on mechanisms to avoid any provision of care by the student and to maintain the student’s stance as a learner.

In settings where hands-on care will be provided, the following additional criteria must be met:

QUALIFIED PRECEPTORSHIP: An appropriately qualified preceptor has been identified and is willing to precept the student for clearly articulated clinical actions.
PATIENT SAFETY: The site has in place robust protections for patient safety.
NET IMPACT: The student, faculty sponsor, and site have identified potential negative and positive short and long-term impacts of including the student in the provision of care.

Required agreements and approvals

All coursework abroad must have a project agreement and relevant institutional agreements in place. The nature of these agreements varies slightly by the type of project. These are described by activity group below.

Observation only

Exploration Seminar or Other Observational Course: All exploration seminars or courses are approved by the relevant bodies, so there is no need for additional approval. Students may simply register for the course.

Educational projects and activities

Undergraduate Clinical (no hands-on care): Undergraduate NCLIN courses in community or population health that do not involve hands-on care may be available. All international non-care rotations require a Memoranda of Understanding (MOU) and/or an affiliation agreement (AA). Students sign all relevant clinical forms.

Population Health DNP Practicum: Clinical practicums for non-licensure DNP tracks such as community or population health do not involve hands-on care. An institutional MOU is required. Students, chair and an authorized individual from the participating agency additionally sign a statement of mutual agreement (SMA) outlining specifics related to onsite activities, access to materials, timelines and deliverables.

DNP Final Projects: Final projects involve health-related activities such as community needs assessments, evaluation of clinical training, or quality improvement. They do not involve the delivery of care. Proposed projects are submitted for consideration via the established DNPCC process. Following a student matching with a project, the student’s DNP committee reviews the proposed project and approves based on criteria described above and the presence of an appropriate agreement. An MOU and SMA are required.

Independent Study: Students may work with faculty at the UW to design a project for independent study or study abroad that does not involve hands-on care. The faculty sponsor and student sign the independent study (NMETH 499/600) form agreeing to objectives and affirming the presence of required agreements. The Independent Study form must be signed and on file prior to departure. The student registers for credit with the approving faculty member. An SMA is required.

Delivery of clinical care

Undergraduate clinical care rotations and clinical practicums for DNP tracks leading to ARNP licenses are established by the School of Nursing and governed by the Washington Administrative Code. Students sign all relevant clinical forms. In addition to the availability and commitment of an on-site qualified preceptor, the sites must sign an affiliation agreement prior to the student’s arrival. International affiliation agreements are considered non-standard by the UW and are therefore negotiated by UW Global Affairs and the UW Attorney General’s office. These are established at the school level to ensure long-term commitments and are not established by individual students for one-off experiences.

Table 1: Quick Guide for International Study Requirements

	MOU	AA	SMA
Undergraduate clinical – no hands-on care	(X)	(X)*
DNP clinical – no hands-on care (Pop Health)	X		X
DNP final project	X		X
Independent study			X
Clinical rotations – hands-on care	X	X

*parentheses denote either/or

Pre-departure orientation

All students must attend travel orientation prior to departure. If not provided by the course or program, the Office of Study Abroad, the Center for Global Health Nursing, and the Department of Global Health can refer to opportunities. If no in-person training is available, students will meet and complete a pre-departure checklist with their faculty sponsor.

All students must register their travel with the UW Office of Global Affairs and ensure insurance coverage. See the UW Student International Travel Policy for additional information.

Other considerations

The UW School of Nursing maintains a number of MOUs with numerous institutions worldwide, thus students are strongly encouraged to identify projects through their degree programs or through faculty members with existing partners
Students interested in international experiences are strongly encouraged to start planning early and contact faculty who may offer possible projects
Explore opportunities for travel scholarships – these are available but can be competitive
Consider timing given other course scheduling
Some international partners may allow projects that are Seattle-based during the academic calendar, with travel and on-site work during the summer

Revised February 2018