Year 3: PREP LTC Enrollment Form

Thank you for your interest in Ontario CLRI’s PREP LTC initiative. By completing this form, you enroll your LTC home in PREP LTC for Year 3.

Once you complete this form and click submit, you will receive an email with a copy of your responses and a UNIQUE LTC HOME LINK FOR STUDENT REGISTRATION.

Select your LTC home(Required)

If you are unable to select your LTC home from the list, please contact us before continuing at prepltc@the-ria.ca.

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Home Name

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PREP Allotment

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Address

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City

Province

Postcode

The Primary PREP LTC Contact will be sent the link to register students and will receive all the email confirmation for students registered. This individual will also receive email announcements about PREP LTC and will receive the final funding amount confirmation notice.

Primary PREP LTC Contact(Required)

Phone(Required)

Phone Ext.

Email(Required)

Job Title(Required)

Please enter an alternate contact such as the DOC, Finance/Operations, HR, etc. This individual will receive the PREP LTC announcements and the final funding amount confirmation notice along with the primary contact.

Alternate Contact Name(Required)

Alternate Contact Phone(Required)

Alternate Contact Phone Ext.

Alternate Contact Email(Required)

Alternate Contact Job Title(Required)

How did you hear about PREP LTC?(Required)

Other (please describe)(Required)

Please select the type(s) of students that completed or are planning to complete their clinical placements at your long-term care home between April 2023 and March 2024. (Select all that apply)(Required)

Other (please describe)(Required)

Who supervises PSW, nursing students (PN, BScN and NP), and IEN/SPEP candidates for their clinical placements in your LTC home? (Select all that apply)(Required)

Personal Support Worker

Registered Practical Nurse

Registered Nurse

Nurse Practitioner

Doctor/Physician

Educator/Instructor

Other (please describe):

N/A, we do not have staff who are able to supervise clinical placements

Other (please describe)(Required)

Please estimate the number of PERSONAL SUPPORT WORKER preceptors your LTC home has or will have to supervise students during their clinical placement.(Required)

Please estimate the number of REGISTERED PRACTICAL NURSE preceptors your LTC home has or will have to supervise students during their clinical placement.(Required)

Please estimate the number of REGISTERED NURSE preceptors your LTC home has or will have to supervise students during their clinical placement.(Required)

Please estimate the number of NURSE PRACTITIONER preceptors your LTC home has or will have to supervise students during their clinical placement.(Required)

Please estimate the number of DOCTOR/PHYSICIAN, EDUCATOR/INSTRUCTOR or OTHER preceptors your LTC home has or will have to supervise students during their clinical placement.(Required)

What aspects of your student placement program would you like to develop or improve for your LTC home? (Select all that apply)(Required)

Better onboarding process and procedures

More or improved tools for recruiting students from schools

More or improved tools for recruiting students from placements into team member positions

More or improved training materials and resources for students

More or improved training materials and resources for preceptors

Improvement to the physical infrastructure of LTC home for students (e.g., more dedicated spaces for students, more lockers)

Improved coordination between schools and LTC homes regarding student placement needs (i.e., what is the expectation of the school regarding the placement experience)

Other:

Other (please explain):(Required)

What factors are limiting your LTC home’s capacity to accept more PSW or nursing students for their clinical placements?(Required)

If your LTC home enrolled/participated in PREP LTC in Year 1 (2022-2023) or Year 2 (2023-2023), how satisfied are you with the PREP LTC program?

Very satisfied

Satisfied

Neutral

Unsatisfied

Highly Unsatisfied

N/A, we did not participate in PREP LTC in year 1 (2022-2023) or year 2 (2023-2023)

If my LTC home (selected above) receives PREP LTC funding, I acknowledge the use of funds to support student placements from Apr. 1, 2023-Mar. 31, 2024, and that a team member(s) supervised/mentored them. I agree to use received PREP LTC funds by Mar. 31, 2024, to backfill preceptors' time or provide honoraria to appreciate them.(Required)

Yes

Student Placement Coordinator Registration

Would your long-term care home like to register for funding for a student placement coordinator ($30,000 per LTC home to fund a 0.5 FTE)?(Required)

Yes, START-UP FUNDING to initiate a new student coordination role in your home

Yes, EXPANSION FUNDING to expand or improve the existing student coordination role(s) in your home

No, I would not like to register at this time for student placement coordinator. (If you would like to register for this funding in the future, please contact your REL or prepltc@the-ria.ca).

For student placements, does your LTC home have relationships with school boards, public colleges, private colleges, Indigenous Peoples Institutes or universities? (Select all that apply)(Required)

School boards

Public colleges

Private colleges

Indigenous Peoples Institutes

Universites

Not Applicable, our LTC home does not have relationships with schools

What orientation processes are in place for new students completing their clinical placements at your LTC home? (Select all that apply)(Required)

Other: please describe(Required)

Do you have an evaluation process in place to receive feedback from students and preceptors that participate in your student placement program?(Required)

Yes, we have a formal evaluation process

Somewhat, we have an informal evaluation process

No, we have no evaluation process

How do you evaluate student placements in your LTC home? (Select all that apply)

Use a standardized tool created by our LTC home/Team members

Use an academic institution evaluation tool

Informal reporting process

What recruitment processes are in place at your LTC home for students who are completing their placements and will soon be entering the LTC workforce?(Required)

No recruitment process

Review job description/job posting

Focused job training for students in their last placement

Providing incentives (e.g. travel stipend)

Other:

Other (please describe):(Required)

In the past two years, has your LTC home hired a student(s) into a formal staff role who completed their placement at your LTC home? (i.e., hired a PN student who completed their clinical placement at your LTC home as an RPN after they have graduated)(Select all that apply)(Required)

PSW Student

PN Student

BScN Student

IEN

No, we have not hired a student(s) into a formal staff role in the past two years

What onboarding processes are in place at your LTC home for newly graduated students who are joining your staff as team members? (Select all that apply)(Required)

No formal process

Staff orientation

LTC home tour

Mandatory/Required Training(s)

Other:

Other (please describe):(Required)

What impact do you anticipate that funding for a Student Placement Coordinator will have on your LTC home’s ability to increase the number of PSW and nursing students you accept for clinical placements in 2023-2024?(Required)

0%-5% increase in PSW and nursing students

6%-10% increase in PSW and nursing students

11%-15% increase in PSW and nursing students

16%-20% increase in PSW and nursing students

21% or greater increase in PSW and nursing students

Not applicable, funding for a student placement coordination will not increase the number of PSW or nursing students our LTC home can accept in 2023-2024

What impact do you anticipate that funding for a Student Placement Coordinator will have on your LTC home’s ability to increase the number of PSW and nursing students who are hired as team members in 2023 2024?(Required)

0%-5% increase in students and IENs who are hired as team members

6%-10% increase in students and IENs who are hired as team members

11%-15% increase in students and IENs who are hired as team members

16%-20% increase in students and IENs who are hired as team members

21% or greater increase in students and IENs who are hired as team members

Not applicable, funding for student placement coordination will not increase the number of students and IENs who are hired as team members by our LTC home in 2023-2024

What outside factors are preventing your home from taking in students?

I acknowledge that my home (as selected above) will use PREP LTC funding for coordination to start up or expand student placement coordination support.(Required)

Yes

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