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Master of Nursing Practicum Forms

Master of Nursing (MN) Students will be expected to complete one nursing practicum course. Nursing practicum experiences occur in any of the following settings in consultation with their Course Professor: health care facilities, community organizations, professional agencies, government agencies, education settings. The practicum allows the opportunity to advance and apply students' knowledge and skills in a variety of specialty areas of nursing practice. Example: clinical, research, education, policy, quality improvement and administration.

Refer to the  (PDF file) MN Practicum Package 2024-2025 (opens in new window)  for important details about practicum.

Once the practicum has been reviewed and approved by their Course Professor, students must complete the Practice Requirement Record (PRR) form and the Practicum Request Form (PRF) by the deadlines specified in the tables below.

DCSN has engaged with Synergy Gateway to provide access to Verified (external link, opens in new window) . Students are expected to submit all PRR forms as per the specific year and program. Students will receive an email from Synergy with an activation link to create an account in Verified, once the submission process opens for each semester. Students who already have an account can access their Synergy Dashboard. Please review the PRR package below for additional process details.

Practicum Request Form

The Practicum Request Form allows students to provide details regarding their nursing practicum experience that will meet the objectives for their program.

Practice Requirement Record

The PRR form demonstrates that students meet the specific health and safety needs of placement partners.  It also proves that students abide by the requirements mandated by Ontario legislation for those entering into healthcare practice settings. 

Students will complete the PRR form on an annual basis.

All nursing students enrolled in practice courses must have their PRR completed and signed by their healthcare provider(s). Completion of all sections of the PRR form, by the dates specified on the form, is compulsory.  

This process is necessary to ensure that students protect their health and safety, and the health and safety of patients, clients, residents, visitors, employees and other students.

Student should allow themselves two to three months to complete their PRR. Students will need to present documentation for all required elements identified on the form by the deadline.

Without a complete PRR, placement partners can refuse students entry to their placement.

The PRR form includes the following medical requirements and non-medical requirements. 

Communicable Diseases - Measles, Mumps, Rubella (MMR) and Varicella

  • Proof of MMR-V Primary Series Vaccination or 
  • Serology/Laboratory Evidence of Immunity

Hepatitis B

  • Proof of Primary Series Vaccination and Serology/Laboratory Evidence of Immunity

Diphtheria and Tetanus

  • Proof of the last Diphtheria and Tetanus vaccinations within the past ten years, and must be valid for the entire academic year

Pertussis

  • Proof of a one-time acellular Pertussis vaccination (TDaP or TDaP-IPV) given at age 18 years or older. If this information is no longer available, repeat the vaccination

Polio

  • Proof of Primary Vaccination only

Tuberculosis (TB) Screening

  • If Negative: Proof of Baseline 2-Step TB Skin Test required and Annual Step-1 TB Skin Test if Baseline was completed a year ago OR
  • If Positive: Proof of Chest X-Ray (CXR) report less than two years old, and must be valid for the entire academic year

Influenza Vaccine (For Winter Placements Only)

  • Proof of vaccine administered between October - December. This must be submitted for Winter Placement eligibility

COVID-19 Vaccine

College of Nurses of Ontario (CNO) Registration License

Your CNO registration will be verified at cno.org (external link) 

Any student with changes in their CNO registration status (example: status not in good standing; suspension; lapsed and/or revoked) must disclose to the Daphne Cockwell School of Nursing

Vulnerable Sector Screening/Check  

The CPO will automatically email all students enrolled in a practice course the Toronto Police form (M-postal code) or a Letter of Request (non-M postal code) to apply for a VSS each semester. Please do not email the CPO requesting for the form or letter. To avoid delays, please ensure your postal code is updated on HSPnet, this is how the CPO determines which document to send you.

Placement Semester
 Expect Email from CPO
Fall  Beginning of May
Winter Beginning of October

Mask Fit Testing  

Proof of mask fit testing for N95 respirators is a mandatory requirement for nursing practice placements. This testing occurs every two years.  

The Daphne Cockwell School of Nursing will offer mask fit testing twice a year on campus. This information will be shared with students once dates are confirmed.

Students who are unable to attend a scheduled session must arrange their own mask fit testing. It is your responsibility to arrange your own mask fit testing. There are several agencies across the GTA that offer mask fit testing for a fee, including, but not limited to:

At the end of your test, you will be provided with a mask fit test card. You will be required to show your mask fit test card annually for nursing practice placement clearance, as well as to your placement agency. 

If you are currently employed at a healthcare agency and have completed a mask fit test, you do not need to book a separate test. Please note that the mask fit must be valid for the full duration of your academic year.

Cardiopulmonary Resuscitation (CPR) Basic Life Support 

You are responsible for arranging your own CPR classes at the Basic Life Support (BLS) level only. Basic Life Support (CPR-BLS) is renewed on an annual basis and must be valid for the entire academic year.

Advanced CPR certificates are accepted if valid for the full academic year.

Forms and Deadlines