18 Volume 78 • Number 8A D V A N C E M E N T O F T H E .docx

18 Volume 78 • Number 8
A D V A N C E M E N T O F T H E SCIENCEA D V A N C E
M E N T O F T H E SCIENCE
C I A L R E P O R T
Introduction
Hazardous Substances in E-Waste
The composition of e-waste is incredibly
miscellaneous. E-waste contains complex
mixtures of potential environmental con-
taminants that are distinct from other forms
of waste (Robinson, 2009). It contains more
than 1,000 different substances that fall
under “hazardous” and “nonhazardous” cat-
egories (Ministry of Environment and For-
ests, 2008). Due to the presence of a large
number of hazardous substances including
heavy metals (e.g., mercury, cadmium, lead,
etc.), flame retardants (e.g., pentabromo-
phenol, polybrominated diphenyl ethers
[PBDEs], tetrabromobisphenol-A, etc.), and
other substances, e-waste is generally con-
sidered hazardous, and if improperly man-
aged, may pose significant environmental
and health risks (Tsydenova & Bengtsson,
2011). Some potential contaminants in
e-waste are so uncommon that little research
has been conducted on their disposal conse-

quences. Further, chemical composition of
e-waste varies depending on the age and type
of the discarded item as some new chemicals
are introduced into electrical and electronic
equipment (EEE) from time to time while
other chemicals are restricted. For instance,
e-waste composition is changing with tech-
nological development and pressure on
manufacturers from regulators and nongov-
ernmental organizations (NGOs) (Robin-
son, 2009). The replacement of cathode ray
tube (CRT) monitors with liquid crystal dis-
plays (LCD) is a constructive advancement
in this context as it reduces the concentra-
tion of lead in e-waste. LCD displays, how-
ever, contain the heavy metal mercury.
Furthermore, e-waste contains certain pre-
cious metals such as gold, silver, and copper.
This provides incentives for recycling and
makes e-waste economically significant. For
instance, precious metal concentrations in
printed circuit boards are more than tenfold
higher than commercially mined minerals
(Robinson, 2009). Platinum group metals are
included in EEEs due to their high chemical
stability and conductance of electricity (Rob-
inson, 2009). Thus, a hidden treasure lies
beneath the ever-growing mountain of e-waste.
Some 820,000 tons of copper are included in
the annual flow of e-waste (Robinson, 2009).
Health Hazards Related to E-Waste
Treatment

E-waste treatment including simple recycling,
burning, chemical digestion, and disposal
practices exposes the workers and area resi-
dents to high levels of toxicity through mech-
anisms such as inhalation, contact with soil
and dust, dermal exposure, and oral intake
of contaminated locally produced food and
drinking water. Unregulated recycling activi-
ties generate workplace and environmental
contamination by a wide range of chemi-
cals. Methods used for recycling of e-waste
release toxic metals (such as lead) as well as
persistent organic pollutants (POPs) into the
environment (Wong et al., 2007). Inhalation
and dust ingestion are suggested as particu-
larly important routes of human exposure.
An assessment of risk from dust ingestion
conducted by Leung and co-authors (2008)
revealed that ingestion of lead- and copper-
contaminated dust may pose serious health
risks to workers and local residents. For
instance, for a printed circuit board recycling
worker, the estimated oral average daily dose
of lead exceeded the ‘‘safe” oral reference
dose for lead by 50 times. Available evidence
demonstrates that e-waste-related mixtures
(EWMs) contain both chemicals present in
EEE components and chemicals released dur-
ing e-waste combustion (Frazzoli, Orisakwe,
Dragone, & Mantovani, 2010). EWMs can
enter living organisms, from food-producing
A b s t r a c t Technological waste in the form of electronic
waste
(e-waste) is a threat to all countries. E-waste impacts health and
the

environment by entering the food chain in the form of chemical
toxicants
and exposing the population to deleterious chemicals, mainly in
the form
of polycyclic aromatic hydrocarbons and persistent organic
pollutants.
This special report tries to trace the environmental and health
implications
of e-waste in India. The author concludes that detrimental
health and
environmental consequences are associated with e-waste and the
challenge
lies in producing affordable electronics with minimum chemical
toxicants.
Anwesha Borthakur
Centre for Studies in Science Policy
Jawaharlal Nehru University
Health and Environmental Hazards
of Electronic Waste in India
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April 2016 • Journal of Environmental Health 19

A D V A N C E M E N T O F T H E SCIENCE
animals to humans, through the gastrointes-
tinal tract as well as lungs and skin (Frazzoli
et al., 2010). Toxicants in EWMs are gener-
ally POPs. POPs are the substances that are
resistant to biodegradation, have a strong
tendency to bioaccumulate in the food chain,
and are prone to long-range transport. It has
been reported that POPs have the potential
to transfer from one generation to another
through breastfeeding (Frazzoli et al., 2010).
Hence, it is a pollutant not only of significant
concern for the current generation but also
for their offspring.
Effects on Food Crops
Fu and co-authors (2008) carried out a
study in Taizhou in southeast China, which
is the biggest e-waste recycling area in Zhe-
jiang Province. Taizhou is also an important
agricultural area in Zhejiang Province, and
rice serves as the major crop for the local
people. The authors investigated the heavy
metal contents in rice samples from a typi-
cal e-waste recycling area. Ten heavy met-
als including copper, cadmium, and lead
were found in 13 polished rice and relevant
hull samples. Six paddy soil samples were
also investigated. The results showed that
the agricultural soil in Taizhou was most
severely contaminated by cadmium, fol-
lowed by copper and mercury. Moreover,
the concentration of heavy metals such as
lead and cadmium in rice near e-waste recy-

cling sites was higher than those from other
areas. The authors hypothesized the prob-
ability of lead intake by the local inhabitants
being higher than the limit prescribed by the
World Health Organization.
Effects on Child Health
Liu and co-authors (2011) carried out a
study aimed at evaluating the dose-depen-
dent effects of lead exposure on tempera-
ment alterations in children from a primi-
tive e-waste recycling area in Guiyu, China,
and a control area Chendian, China. It is
widely known that environmental expo-
sure to pollutants results in accumulation
of lead and other toxic substances in chil-
dren. The results showed higher blood lead
levels (BLLs) in Guiyu children. Primitive
e-waste recycling may threaten the health
of children by increasing BLLs and altering
children’s temperaments. This is because
lead exposure produces a wide spectrum of
health outcomes, most notably neurocogni-
tive and behavioral deficits in response to
pre- or postnatal exposures (Liu et al., 2011).
Child exposure to lead has been related to
irreversible decreases in intelligence. The
authors suggested that it is necessary to make
policy changes to restrict e-waste recycling
to certain areas so that children’s exposure to
chemical toxicants can be limited.
Contamination of Food Chains by the
Toxicants From E-Waste
EWMs may accumulate in agricultural lands
and be available for uptake by grazing live-

stock. Persistent bioaccumulating pollut-
ants are of top concern from the standpoint
of food chain contamination (Frazzoli et
al., 2010). In general, chemicals from EWMs
have slow metabolic rates in animals and
may bioaccumulate in tissues and be avail-
able in edible products, such as eggs and
milk (Frazzoli et al., 2010). For instance,
PBDEs are lipophilic, resulting in bioaccu-
mulation in organisms and biomagnification
in food chains (Robinson, 2009). Studies
reported e-waste contaminants in breast
milk. The reporting of e-waste toxicants in
milk is a major concern as dairy animals have
productive lives much longer than meat-
producing animals. Hence, a greater chance
exists for bioaccumulation. It is noteworthy,
however, that bioaccumulation occurs also
in the adipose tissue, liver, and fatty portion
of meat (Robinson, 2009). Bioavailability
and bioaccumulation factors in aquatic spe-
cies for polychlorinated biphenyls (PCBs)
and PBDEs from e-waste sites were shown
by Wu and co-authors (2008). Frazzoli and
co-authors (2010) highlight the impacts of
Effects of E-Waste Components on Health
Source of E-Wastes Constituent Health Effects
Solder in printed circuit
boards, glass panels, and
gaskets in computer monitors
Lead • Damage to central and peripheral
nervous systems, blood systems, and

kidney damage.
• Affects brain development of children.
Chip resistors and
semiconductors
Cadmium • Toxic irreversible effects on human health.
• Accumulates in kidney and liver.
• Causes neural damage.
• Teratoenic.
Relays and switches, printed
circuit boards
Mercury • Chronic damage to the brain.
• Respiratory and skin disorders due to
bioaccumulation in fish.
Corrosion protection of
untreated and galvanized
steel plates, decorator or
hardner for steel housings
Hexavalent chromium • Asthmatic bronchitis.
• DNA damage.
Cabling and computer
housing
Plastics including
polyvinyl chloride
Burning produces dioxin. It causes
• reproductive and developmental problems,
• immune system damage, and
• interference with regulatory hormones.

Plastic housing of electronic
equipments and circuit
boards.
Brominated flame
retardants
• Disrupts endocrine system functions.
Front panel of cathode
ray tubes
Barium Short-term exposure causes
• muscle weakness, and
• damage to heart, liver, and spleen.
Motherboard Beryllium • Carcinogenic (lung cancer).
• Inhalation of fumes and dust causes chronic
beryllium disease or beryllicosis.
• Skin diseases such as warts.
Source: Ramachandra & Varghese, 2004.
TABLE 1
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improper disposal of e-waste on the overall

environment. It not only creates pollution,
but also adversely affects the food chain, and
thus health. Effects of e-waste components
on health are listed in Table 1.
Hazards and Risks Associated
With E-Waste Treatment in India
Recycling of e-waste is a very lucrative busi-
ness in India and dominated by informal
actors (Manomaivibool, 2009). E-waste in
India is often processed to recover valuable
materials in small workshops using rudi-
mentary recycling methods (Tsydenova &
Bengtsson, 2011). For instance, during the
manual dismantling process in informal
Laws and Regulations in India Relating to E-Waste
Law or Regulation Major Content Status/Date
Environment (Protection) Act, 1986
(amendment 1991)
An umbrella legislation that empowers the central government
to take measures to
protect and improve environmental quality and control and
reduce pollution from all
sources.
Effective from
November 19, 1986
Hazardous Wastes (Management and Handling
and Transboundary Movement) Rules, 2008
(amendments July 2009, September 2009)

Provides stipulations on the management, disposal, and
transboundary movement of
solid waste of a hazardous nature (encompassing provisions of
the Basel Convention) as
mentioned in schedules I, II, III, and IV of the rule.
Effective from
September 24, 2008
Municipal Solid Wastes (Management and
Handling) Rules, 2000
Provides compliance criteria to municipalities for the
collection, segregation, storage,
transportation, processing, and disposal of municipal solid
wastes.
Effective from
September 25, 2000
Batteries (Management and Handling) Rules,
2001
Confers responsibility for the safe disposal and recycling of
used lead acid batteries on
the manufactures/assemblers/importers.
Effective from
May 16, 2001
The Hazardous Wastes (Management and
Handling) Amendment Rules, 2003
Under schedule 3 of this rule, e-waste is defined as “waste
electrical and electronic

equipment [EEE] including all components, subassemblies, and
their fractions except
batteries falling under these rules.” The definition provided here
is similar to that of Basel
Convention. E-waste is only briefly included in the rules with
no detailed description.
Notified on
May 20, 2003
The E-Waste (Management and Handling)
Rules, 2011
A recent initiative meant exclusively to address e-waste. Here,
“EEE” means equipment
that is dependent on electric currents or electromagnetic fields
to be fully functional and
“e-waste” means waste EEE, whole or in part or rejects from
their manufacturing and
repair process, which are intended to be discarded. These rules
are meant to be applied
to every producer, consumer, or bulk consumer involved in
manufacturing, sale purchase,
and processing of EEE, collection centers, dismantlers, and
recyclers of e-waste.
Emphasises on extended producer responsibility.
Effective from
May 1, 2012
The Public Liability Insurance Act, 1991
(amendment 1992)
Covers accidents involving hazardous substances and insurance
coverage for these. Effective from
January 23, 1991

National Environmental Tribunal Act, 1995 Provide for strict
liability for damage arising out of accidents caused from the
handling
of hazardous substances. (The tribunal shall become defunct and
the act shall stand
repealed upon the enactment of the National Green Tribunal Bill
2009 currently pending
in parliament.)
Effective from
June 17, 1995
The Water (Prevention and Control of Pollution)
Act (amendment 1988)
Provide for the prevention and control of water pollution and
for maintaining or restoring
of wholesomeness of water in the country.
Effective from
March 23, 1974
The Water (Prevention and Control of Pollution)
Cess Act, 1977 (amendment 2003)
Provide for the levy and collection of a cess on water consumed
by persons operating
and carrying on certain types of industrial activities. This cess
is collected with a view
to augment the resources of the central board and the state
boards for the prevention
and control of water pollution constituted under the Water
(Prevention and Control of
Pollution) Act, 1974.

Effective from
December 7, 1977
The Air (Prevention and Control of Pollution)
Act, 1981 (amendment 1987)
Provide for the prevention, control, and abatement of air
pollution in India. Effective from
March 29, 1981
Source: Adopted from Wath, Vaidya, Dutt, & Chakrabarti,
2010.
TABLE 2
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dismantling and recycling sites, e-waste
recyclers use chisels, hammers, and cutting
torches to open solder connections and sepa-
rate various types of metals and components
(Duan et al., 2011). Wong and co-authors
(2007) listed some of the common crude
recycling techniques related to e-waste in
developing countries such as India. These are
1) stripping of metals in open-pit acid baths
to recover valuable metals as silver, gold,
copper, and platinum; 2) removing electronic
components from printed circuit boards by
heating over a grill using honeycombed coal

blocks (coal mixed with river sediment that
is contaminated) as fuel; 3) chipping and
melting plastics without proper ventilation;
4) burning cables for recovering metals, and
also burning unwanted materials in open air;
5) disposing unsalvageable materials in the
fields and riverbanks; 6) toner sweeping; and
7) dismantling electronic equipment. Ha and
co-authors (2009) attempted to evaluate the
contamination by trace elements at e-waste
recycling sites in Bangalore and Chennai,
India, and accordingly measured trace ele-
ments (TEs) in soil, air dust, and human hair
collected from e-waste recycling sites and
the reference sites in both places. The results
suggest that e-waste recycling and its disposal
may lead to environmental and human health
contamination by some TEs. As observed by
Brigden and co-authors (2005), high levels of
cadmium, copper, lead, and zinc were char-
acteristic of ash collected from two waste
burning operations in New Delhi, India, at
Ibrahimpur and Shashtri Park.
Hazards and Risks Associated With
Manual Disassembling of CRTs
Discarded computer monitors and televi-
sion sets are identified as hazardous materi-
als due to the high content of lead in their
CRTs. CRTs are broken to remove cop-
per yokes that are further used for copper
recovery through the manual disassembly
process. Environmental pollution is a likely
outcome of the breaking and further han-
dling of CRTs. In India, CRTs were report-
edly smelted for recovery of glass, but prior

to the treatment they were stored in an open
area (Brigden et al., 2005). The open air
storage and dumping of CRTs raise concerns
about the possibility of lead contained in the
CRT glass leaching out into the environment
(Tsydenova & Bengtsson, 2011).
Manual Disassembling of Printed
Circuit Board Assemblies (PCBAs)
PCBAs are one of the fastest growing sources
of waste in many developing countries and
spotlight the need to recycle, recover, and
reuse materials that have been consigned to
informal dismantling sites (Duan et al., 2011).
The techniques used for PCBA dismantling in
India mainly involves primitive open-solder-
ing methods. In countries like China and India,
immature technologies are the main obstacle
to the recycling of waste PCBAs. Duan and
co-authors (2011) noted that PCBAs, which
are more complicated and difficult to process,
are simply cooked on a coal-heated plate and
melted (on the iron plate or flat wok) in order
to resell the chips and other recovered compo-
nents to acid strippers for further processing.
The study shows that the dismantled PCBAs
have a significant environmental impact
because they contain heavy metals and halo-
gen-containing flame retardants, such as lead
(soldering tin), mercury (switches, round cell
batteries), cadmium (pins), brominates, and
mixed plastics that can seep into the environ-
ment if not properly managed. Further, cell
batteries may ignite or leak potentially hazard-
ous organic vapors if exposed to excessive heat

or fire and explosion may result if a capacitor
is subjected to high currents and heating.
Recovery of Metals
The most common practice used for the recov-
ery of metals from e-waste in India includes dis-
solving of the metals in strong acid solutions.
Mixtures of concentrated nitric acid and hydro-
chloric acids were reportedly used in Delhi
for the extraction of gold and copper, respec-
tively (Tsydenova & Bengtsson, 2011). Aside
from the obvious health and safety concerns
that arise from the handling of concentrated
acid solutions in these workshops, indications
from workers that the contaminated spent acid
wastes are simply disposed of in land also raises
substantial environmental concerns (Brigden et
al., 2005). Further, various volatile compounds
of nitrogen and chlorine are known to be emit-
ted during such processes.
Processing of Plastics
Plastics are manually removed from e-waste
and mechanically shredded (Tsydenova
& Bengtsson, 2011). The next treatment
step may be some kind of separation (e.g.,
by color or density) or further grinding.
E-waste parts are burned on open fires to
recover metals from plastics in which they
are encased; this includes plastic coated
wires as well as other complex components
(Tsydenova & Bengtsson, 2011).

Major Environmental Pollutions
From E-Waste
Disposal of e-waste in an environmentally
acceptable manner is a major challenge.
Most e-waste today is landfilled, which is
not a sustainable practice. Although recy-
cling may remove some contaminants, large
amounts may still end up concentrated in
landfills, adversely affecting human health
or the environment. An article by Sepùlveda
and co-authors (2010) assessed the mag-
nitude of environmental contamination at
e-waste recycling sites in China and India
by comparing the data with known concen-
tration thresholds and other pollution level
standards. The review highlighted very high
levels of lead, PBDEs, etc., in air, bottom ash,
dust, soil, water, and sediments in e-waste
recycling areas of the two countries suggest-
ing a serious threat to the environment and
human health.
Air Pollution
Dust is a major air pollutant produced in
e-waste treatment sites during dismantling.
Many e-waste contaminants are spread into
the air via dust (Robinson, 2009). This
is a major exposure pathway for humans
through ingestion, inhalation, and skin
absorption. Brigden and co-authors (2005)
screened dust samples from the e-waste
recycling workshops involved in desol-
dering and PCBA disassembly in China and
India, which showed exceptionally high
concentrations of lead and tin. Incineration,
carried out as a disposal measure of e-waste

(especially the open-air burning of plastics
in order to recover copper and other met-
als), has the potential to emit toxic fumes
and gases into the environment, thereby
polluting the surrounding air. Moreover,
obsolete refrigerators, freezers, and air con-
ditioning units contain ozone-depleting
chlorofluorocarbons, a potential air pollut-
ant. Thus, both e-waste recycling and dis-
posal areas are potential air pollution sites.
JEH4.16_PRINT.indd 21 3/3/16 8:00 AM
Water Pollution
Both ground and surface water pollution are
major concerns near to the e-waste recycling
sites. E-waste contaminants can enter aquatic
systems via leaching from dumpsites where
processed or unprocessed e-waste may have
been deposited. Similarly, the disposal of acid
following hydrometallurgical processes into
waters or onto soils, as well as the dissolution
or settling of airborne contaminants, can also
result in the contamination of aquatic systems
(Robinson, 2009). Several studies indicated that
Guiyu, China, a thriving area of illegal e-waste
recycling, is facing acute water shortages due
to the contamination of water resources. The
whole ecosystem in Guiyu has been affected
by the intensive recycling activities, especially

acid leaching operations taking place along the
rivers (Tsydenova & Bengtsson, 2011). Now
water is being transported from far away towns
to cater to the demands of the local population
(Ramachandra & Varghese, 2004).
Soil Pollution
Soil pollution is a major apprehension in
e-waste landfill sites. Soil acidification is a
common occurrence. Mercury leaches when
certain electronic devices are destroyed.
The same is true for PCBs from condensers
(Ramachandra & Varghese, 2004). Ha and
co-authors (2009) reported that soils at an
e-waste recycling slum in Bangalore had con-
centrations of chemical toxicants some one
hundredfold higher than those found at a
nearby control site in the same city.
Legislation in India Related
to E-Waste
In India, policy level initiatives, both in the
form of regulatory regimes and market-based
policy initiatives related to e-waste, are still
inadequate. For instance, the IT revolu-
tion started in India back in the early 1990s,
whereas a proper policy related to e-waste was
introduced almost 20 years later, in 2011, in
the form of the “E-Waste (Management and
Handling) Rules, 2011.” Although market-
based policies have great potential to initiate
proper disposal behavior of e-waste, such poli-
cies are not accurately implemented in India.
For instance, some manufacturing giants
claim that they practice extended producer
responsibilities and carry out take-back ser-

vices (a form of market-based policy initiative)
in India. A study carried out by Greenpeace
(2008), however, reveals that global giants
such as Apple, Microsoft, Panasonic, Philips,
Sharp, Sony, Sony Ericsson, and Toshiba have
no take-back services in India. It is notewor-
thy that these are the companies with particu-
larly high market share of EEEs in the coun-
try. Some of them have take-back programs
in countries like the U.S., but they don’t offer
such services in India. These companies indi-
rectly foster the growth of the informal recy-
cling by failing to provide easy and free take-
back services to ensure responsible recycling
(Greenpeace, 2008). Table 2 lists the laws and
regulations in India relating to e-waste.
The Challenge of Producing
EEEs With Minimum Toxicants
When the e-waste problem started gaining
attention, several studies were carried out
to evaluate the hazards from improper treat-
ment and disposal facilities. A number of
studies have been conducted in the informal
recycling sites of the developing countries,
such as in Guiyu and Taizhou, China, and
Delhi and Bangalore, India. All these studies
mark the presence of some potentially harm-
ful chemicals in the e-waste stream. Several
NGOs have been active in putting pressure
on the producers of EEEs to reduce or elimi-
nate the toxic environmental contaminants
in their products. Many producers of EEEs
have responded well and are investigating
innovative ways to enhance safe disposal and

recycling. The European Union’s “Restric-
tion on Hazardous Substances Directive
(RoHS)” enacted in 2003 is a momentous
policy level initiative to restrict the use of
six hazardous components (lead, mercury,
cadmium, hexavalent chromium, polybro-
minated biphenyls, and PBDEs) in EEEs. The
RoHS directive created a new global standard
on hazardous substances in electronics. Fur-
ther, radio frequency identification tags could
provide information about the condition and
composition of electronic products, which
can alert waste recyclers about valuable com-
ponents and potential environmental con-
taminants contained within the end-of-life
product (Robinson, 2009).
Conclusion
This special report discussed the detrimen-
tal environmental and human health con-
sequences of e-waste. The workers in the
e-waste recycling units and local residents
are exposed to the perilous chemicals pres-
ent in e-waste mostly through inhalation,
dust ingestion, dermal exposure, and dietary
intake. The substances present in e-waste
have the capacity to bioaccumulate and bio-
magnify along the food chain. The chemicals
present in e-waste are POPs having long-
term effects both on human health and the
environment. Heavy metal concentration in
e-waste is of great concern. Health effects of
heavy metals such as mercury and lead were
observed among workers working in rudi-
mentary recycling workshops. Air, water, and

soil pollution caused by e-waste recycling/
disposal are of major concern. Efforts should
be made to educate e-waste recycling person-
nel to adopt health and safety measures, for
instance, to wear personal protective equip-
ment, to clean up the environment/surround-
ings after recycling is performed, and so
on. The government should conduct health
screenings from time to time to see if the peo-
ple performing recycling activities have any
of the health effects described and educate
them on how to avoid such health effects.
Further, it is essential to put regulations in
place and enforce them to curtail open burn-
ing, illicit dumping of e-waste, and to restrict
the areas where recycling can take place in
order to control its environmental and health
consequences.
At present the challenges in front of the
global community lie in producing affordable
EEEs with minimum chemical toxicants. A
number of EEE manufactures have taken ini-
tiatives to invent “green” EEEs. A major con-
cern related to green electronics is their high
cost. For instance, although “Energy Star”
products are green and eco-friendly, they
are not affordable to most of the consumers
in countries like India. Further, India needs
a grassroots level education and awareness
agenda in order to sensitize people towards
issues involving e-waste. It is essential to
educate various stakeholders involved in the
e-waste flow about how to handle e-waste,
the ramifications of not handling it correctly,
and the impact of those living close to dis-

posal and recycling sites or even downwind
of it.
Corresponding Author: Anwesha Borthakur,
Centre for Studies in Science Policy, Jawaha-
rlal Nehru University, New Delhi-110067,
India. E-mail: [email protected]
JEH4.16_PRINT.indd 22 3/3/16 8:00 AM
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Duan, H., Hou, K., Li, J., & Zhu, X. (2011). Examining the
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Frazzoli, C., Orisakwe, O.E., Dragone, R., & Mantovani, A.
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Running Head: PRACTICUM PROFESSIONAL EXPERIENCE
1
PRACTCUM PROFESSIONAL EXPERIENCE
3
Amanda Swenty
Discussion Week 6
In the contemporary society, there has been an increasing need
for nursing courses to provide effective practicum programs for
trainees. Practicum courses have brought a great impact on the
field of nursing since it ensures that nursing students can
acquire practical knowledge alongside the theoretical
knowledge that they have learned in class (Anderson & Knorr,
2011). The paper presents an assessment of the progress towards
achieving objectives of the practicum course as well as another
critical issue in nursing informatics.
During the beginning of the practicum course, there
were several objectives that the nursing the students were
supposed to achieve. For example, we were expected to be in a
position to undertake the role of a clinical coordinator to
students using evidence-based practices. The knowledge gained
from the practical course has enabled me to gain skills in
clinical informatics. Moreover, through active participation in
the field course, I was able to participate in conflict resolution
meetings hence I boosted my skills in conflict resolution. I have
also adopted various measures such as active participation in
solving disputes between my colleagues hence I believe I will
perfect my conflict resolution knowledge and skills. Since the

start of the practicum course, I have also managed to gain skills
required in analyzing and effectively evaluating systematically
clinical sites. This has been done through participation in
discussion with my fellow students and also consulting from my
preceptor Ms. Julie Williams.
There are several measures that can be adopted to
ensure that the objectives are undertaken. For instance, to make
the learners enhance the conflict resolution skills, the host
organization should provide a sustainable environment for the
students. During the practicum course, the students should be
treated with respect and given a chance to participate in critical
organizational functions such as conflict resolutions.
Moreover, the learners themselves should be
insightful individuals who are interested in gaining practical
knowledge in nursing informatics. The students should also feel
free to interact with other nursing practitioners as well as the
assigned preceptor.
During the practicum course, there are several
challenges that have been experienced. For example, the nursing
practitioners did not show respect to the students. This is
because they believed that the students were unskilled in the
field and thus could not participate in crucial decision making.
There was also poor communication in the organization that
hindered the operations of the healthcare facility. Moreover, I
experienced difficulties in relating what had been learned in
class to the practical knowledge that was being acquired.
Another challenge that was also experienced was assigning of
unrealistic duties to students in the practicum program.
As nursing students, a health organization is
supposed to give practical knowledge about caring for the
patients as well as assisting the doctor in providing treatment
(Marie, 2016). However, most of the time, I was subjected to
errands and the keeping of files. These challenges can be
avoided if there is a change of attitude towards students on
practicum project as well as teaching relevant information about
nursing to the students.

As a nursing informatics student, I actively
participated in various activities such as managing the health
information of patients who are suffering from different
disorders. My preceptor, Julie Williams did her best in guiding
me and encouraging me to continue working hard to possess
skills in nursing.
In summary, practicum activities have brought a
great impact on the field of nursing since it results in the
gaining of experience among nursing students. The creation of a
sustainable environment for practicum programs can ensure that
students improve their skills.
References
Anderson , L. & Knorr, H. (2011). Practicum programs in
Nursing: Journal of health practices. 1 9 (5) 112-117
Marie, A., (2016). General Nursing: Nursing Practicum.
Retrieved from: http://allnurses.com/general-nursing-
discussion/nursing-practicum-386995.html
Running Head: PRACTICUM PROJECT PLAN 1
PRACTICUM PROJECT PLAN 6
WEEK 5 DISCUSSION
Amanda Swenty
The project seeks to explore the challenges that students
encounter when they want to acquire experience from
institutions from which they can get their hand on the very vital
work experience and the way that such a problem can be
addressed.
Cases of students with the help of their academic institutions to

fail to secure a place from where experienced can be gained in
the field are ubiquitous. The predicament is a product of
numerous numbers of students who want deployment
opportunities against limited opportunities on institution related
to their profession. Previous projects have been set with the
view of addressing this problem and therefore this project was
partly building on the developments that such organizations
made to that effect. What necessitates this project however is
the fact that previous projects have not fully addressed the issue
and this explains why the problem continues to bite to date. The
institutions that have in the past sought to address this problem
include the Bay Area Nursing Resource Centre which sought to
address the problem by ensuring that available opportunities are
used to the greater extent in bid to address this issue. This
project seeks to address the problem in the region of Northeast
portion Winscousin by advancing more the approaches used by
the Bay Area Nursing Resource Centre to solve the problem to
the extent to which it ought to be solved.
This project seeks to address the problem of insufficient
opportunities in Winscousin for students through balancing the
output from the academic institutions with the opportunities that
the medical care in the region can produce at a time.
The goal of the project is to increase the accessibility of
attachment opportunities by medical students as well as
improving the quality of health care in the country
The objectives of the project can be formulated as follows. This
project seeks to address the problem by creating extra
opportunities in the health institution through lobbying the
management of the institution to increase the size of their clinic
so that the additional required nurses to be undertaken by the
students.
To establish a common pool of potential workforce by talking
up with the school to provide a continuous contribution from
which the companies can draw labor through the year is an
objective of the project. To lobby for the revision of the fixed
common attachment period by academic institutions to run

throughout the year so as to create suitable workforce from
which medical centers can draw workforce for extra staffing.
This is another objective of the project.
To improve the medical standards in the country by beefing up
the number of the available workforce through the integration of
more interns in the system that is currently understaffed. This
can be based on the standards that are set by different medical
institutions that unanimously attribute quality medical care with
availability of enough workforces in the health sector.
To solve the problem by using a computer program that shall
help to the quick identification of the emergence of a new
opportunity for attachment in the field is another objective of
the project. To use research in order to arrive at more
convenient ways through which the problem can be addressed
better in the future is another objective of the project. To use
data collected from the monitoring and evaluation sections
within the course of the implementation of the project to rectify
accordingly based on the available information.
The preconditions necessary for the successful implementation
of the project include increased medical allocations by the
government so as to enable extension of the medical facilities in
the region so as to allow the penetration of extra staff in the
form of students who are on field attachment. This increased
allocation on the part of the government will serve to construct
extensions in the hospitals which will not only serve in the
realization of the objectives of the project but also the
attainment of the goal of the government of providing medical
care for all; a condition that is currently unrealized.
Computer software through which the available students for
practicum can be matched with the available attachment
opportunities in the medical institutions in the region for proper
coordination of activities is required. It will be important in the
course of the implementation of the project as it will aid in
bringing sobriety in the manner in which emergent opportunities
are linked to the available workforce. For example, to organize
allocation of the opportunities on the basis of first com first

served.
Time is required for the mobilization of the academic
institutions in the country to create a continuous duration
through which the practicum exercise shall run. This is based on
the fundamental assumptions that different academic
institutions have different activities on their calendar and these
calls for the occurrence of meeting by the respective
stakeholders to deliberate on the matter so as to arrive to a
conclusion and thus taking up a substantial period of time.
Methodology to be used in the project include the use of
computer software in allocating attachment opportunities to
available students on the basis of first available first allocated
consequently last available, last allocated. The use of open
questionnaires will also be put in place so as to get feedback
that can be integrated in the monitoring and evaluation reports
to effect the desirable change during the implementation of the
project. Use of surveys will be adopted to measure the extent to
which the problem is solving the problem it set out to address.
Again, this is paramount to ensure that the project remains
relevant the change to conditions that made the project a
priority might render the project unnecessary in the future.
This project can be justified through the analysis of the data
available that shows the extent to which students in the medical
institutions in the regions are facing challenges in acquiring
practicum opportunities from medical facilities in the country.
According to the anticipations of the Bureau of Labor Statistics
of 2005, there was an expected shortage of one million nurses in
the United States of America by the year 2010. This shameful
trend can be aided by the intervention of this project which calls
for the assistance from all centers including the government as
the well being of the state is anchored on this project.
Formative evaluation of the project will be periodically done at
the end of each implementation stage so as to ensure that the
project is in line with the set out plan. Such laid down plan
include funds which when not clearly administered can lead to
the collapse of the project before it is actualized. It also helps

to gauge whether the project is still relevant by evaluating the
conditions that necessitated it.
Summative evaluation will be done after duration of one year
after the completion of the project so as to measure if the
anticipated outcome of the project were realized. Indicators to
the success of the project include decrease in the number of
persons unable to get internship in the region as well as the
level of medical health in the region which should be better
based on the fact that a larger workforce has engaged the
available patients.
The implementation of the project is expected to take duration
of two years. Additional time from the class schedule will be
allocated so as to ensure the actualization of the project as its
wide scope calls for lengthy periods for actualization.
References
Agnew, M. D., Goodess, C. M., Hemming, D., Giannakopoulos,
C., Salem, S. B., Bindi, M., ... & El-Fadel, M. (2013).
Introduction (pp. 3-21). Springer Netherlands.
Elliott, M. (2002). U.S. Patent No. 6,446,053. Washington, DC:
U.S. Patent and Trademark Office.
O'Leary, Z. (2013). The essential guide to doing your research

project. Sage.
Running Head: PRACTICUM 1
PRACTICUM 6
Week Three Discussion
Practicum, project Goals, and Objectives
Amanda Swenty
Capstone 6600
Walden University
Academic institutions through the country struggle on a daily
basis to make sure that they are preparing student nurses that
are competent to function as a nurse. One point of contention
that academic institutions face is where to place students for
hands on clinical and how and when will the sites be approved.
Throughout the world a roadblock often seen is the fact that
many academic settings are looking for placements and those

needs outweigh the actual sites. Bay Area Nursing Resource
Center (2006) created a plan that allowed for a standardized
approach for clinical placement for multiple academic
institutions and sites. In that plan it is stated that “by
centralizing and standardizing the clinical placement process,
untapped capacity at clinical agencies will be identified and
made available to schools”. The premise of this discussion is to
provide an explanation of why this students feels a passion and
value of creating a program that can be used in the Northeast
portion of Wisconsin.
Current Situation
The current situation that Northeast Wisconsin is facing is
multiple academic institutions all trying to secure placement for
clinical in a limited amount of facilities. The area of Northeast
Wisconsin that will be addressed in the project encompasses
approximately six counties, five academic institutions, eight
acute healthcare facilities, and numerous other healthcare
facilities (such as clinic’s, nursing homes, schools etc.).
Because of the increase of enrollment the nursing programs are
growing, thus employment rates are increasing, limiting the
amount of approved clinical sites in the healthcare facilities.
This has become a problem that needs attention sooner rather
than later.
Greater Breen Bay Health Care Alliance
Currently the academic institutions and healthcare facilities are
work together through a committee known as the Great Green
Bay Healthcare Alliance (GGBHCA). This team meets monthly
with a mission of standardizing processes to enhance
compliance, safety, and documentation. This team has recently
researched the issue of a standardized approach to clinical
placement. The first step was receiving information from the
state of Minnesota who currently uses a standardized approach.
The information seems applicable however there was a $20,000
cost associated for startup and then a $10,000 yearly fee for use

of the software. This student feels that if the proper attention,
collections of resources, and direction by a mentor a plan can be
created that would meet the needs with no cost and managed by
the GGBHCA after the plan is created.
The Plan
The plan for this project will consist of the following step:
· Gathering data- this student will work with the mentor who is
currently a member of the GGBHCA. This information
gathering will shed light on who the key players will be at both
the academic settings and the healthcare facilities. The desire
would be to meet in person with the thirteen placement
coordinators that represent the healthcare facilities/ academic
institutions that will be involved.
· Gather statistical data around admission numbers and current
students needing placement.
· Gather data about what is current course needs (example-
college A needs three med/surg placements, college B needs
five med/surg and one OB, etc.)
· Research current software available for review and creation of
a home grown version that will meet the needs of this situation.
· Presentation of the plan to the GGBHCA
· Schedule a meeting where all key players will be invited to
create an implementation plan and handoff of product and
process to the GGBHCA
Resources
Just like any other project, resourcing are important aspects
upon which the success of the project is anchored. The
resources that are thought to be necessary will be the
technology department. Being that the faculty mentor for this
project is fulltime faculty at one of the key academic settings
the technology will be available. The program director will
play an integral part in the creation of the software.
Evaluation
Monitoring and evaluation of the progress of the project will be
assessed at the end of every task that is oriented towards
attainment of the objectives and therefore the performance of

the different implementation levels can be gauged against the
laid down plans at the onset of the project. The need for this
process is to ensure that the project does not deviate from the
objectives it set out to achieve. Summative evaluation will be
done at the completion of each and every quarter to validate
effectiveness. The GGBHCA will tabulate all evaluations and
thus have the subgroup in charge of changing any processes,
adding or ending any other initiatives.
Expected Roadblocks
Factors that are seen as concerns are timeliness of requesting
data by the academic institutions and then timeliness of
approval or denial back to the academic institutions. The fear is
that reluctance to use the tool may stem for lack of knowledge
and thus an increase in denials will be seen. Education will
need to occur to all players involved in clinical placement to see
the value of this tool.
Linking Objectives
You need to add 2-3 specific, measurable, attainable, results
focused, time focused, objectives…..
After you add the objectives do a quick conclusion that
basically restates the introduction.
References:
Bay Area Nursing Resource Center (2006). Centralized Clinical
Placement System. Retrieved March 17, 2016 from:
bayareanrc.org/files/OperatingManual.pdf

Running Head: PRACTICUM 1
PRACTICUM 2
Practicum
Amanda Swenty
Capstone 6600
Walden University
Standardization of students’ placement in clinical site within
the green bay college system for acute care rotation is a title of
these project which seeks to solves this problem facing a
substantial segment of the society
The need to establish a more convenient way through which
students can get to green bay college system with ease is
apparent. This paper explore for means of serving in this regard
and some of the ways of achieving this broad goal include; the
use of a computer software to enable students easily locate

vacancies in the green bay college system, coordinating all the
hospitals in the domain so as to establish places where students
can be place, working with different colleges so as to enable the
respective schools access the desired positions with ease. The
goal of the project is to use tools that are at my disposal to
standardize the accessibility of positions into the rotation
positions with ease. The aim of the project is use of different
tools such as computer programs to facilitate the accessibility
of student placement opportunities in the society.
This project seeks to investigate the courses of the current
problem in the accessibility of placement opportunities for
students in the society. There are hypothesis upon which the
project is built and these research will be exploring such
relationships with the aim of understanding the issue at hand
better.
To standardize the way students are posted into clinical sites
within the green bay college system for acute care rotation by
the adoption of different clinical placement tools such as a
computer program. The project entails coordinating efforts from
all affected centers in the society amongst them colleges with
affected students, different medical facilities from which
placements can be made as well as the clinical coordinator for
Rasmussen College in Green Bay.
This project seeks to establish a number of correlations that it
deems useful for the resolution of the problem at hand. They
include, establish the correlation between all hospitals in the
neighborhood and students placement into the green bay college
system. Secondly, establish the relationship between respective
colleges and the standard student’s placement in green bay
student system. Thirdly, explore the role of a computer program
in facilitating the accessibility of green bay students system.
Fourthly, explore the role of a member of clinical coordinator
for Rasmussen College in Green Bay in the placement of
students in the green bay students system.
The project can be justified as follows: The increasing difficult
of students to access admission into the acute care rotation if

forcing a rethink in the strategies previous adopted in the
realization of the said goal. A disconnect emerged different
sectors all of which serve to hinder the attainments of such
opportunities. All the failure of students who perform poorly in
exams to get access to such opportunities serves to bring the
aspect of discrimination in the manner in which the
opportunities are accessed by different persons.
Inefficiency of the predominant way of addressing the said
problem in the society therefore calls for a different approach
that will serve in addressing the said problem. The need to
coordinate respective efforts in the society geared to the
attainment of this call become paramount and hence for the
reason of the adoption of this multi-dimensional approach to the
problem. Among the strategies that the project seek to use
include coordinating all colleges affected by the problem, all
the medical facilities akin to the process as well as the use of
computer software in restoring effectiveness in the process of
accessing this crucial service in the country.
Methodology to be adopted in the project will be diverse and
will include the use of computer software that will be developed
for the sole purpose of enabling students seeking for an
opportunity to be attached in the system to gain the opportunity.
Coordination of different centers akin to the process too is
another strategy that the project seeks to use to solve this
problem. For example, coordinating the efforts from the
affected colleges as well as the nearby medical facilities and
important personnel. The computer software to be adopted in
the process will possess the ability of highlighting the vacancies
that are still present for students at the respective centers
making it for students to engage the said opportunities.
Just like any other project, resourcing are important aspects
upon which the success of the project is anchored. The
resources that are deemed paramount to the completion of the
project include human capital in the form of the inputs from the
respective colleges and hospitals as well as technical assistance
from professionals in the society such as the coordinator of

Rasmussen College in Green Bay. Computers and software
developers that can create software to help in this regard too are
inputs required for the actualization of this project. Time is
another resource that will be instrumental for the success of the
projects because different approaches to be adopted by the
project are time oriented.
Monitoring and evaluation of the progress of the project will be
assessed at the end of every task that is oriented towards
attainment of the respect objectives and therefore the
performance of the different implementation levels can be
gauged against the laid down plans at the onset of the project.
The need for this process is to ensure that the project does not
deviate from the objectives it set out to achieve. Again, with
time the relevance of a project can diminish in the event that the
conditions that necessitated the project are no longer an issue
that is troubling the target group and this therefore also help to
ensure that the implementation of the project is justified.
Summative evaluation will be done after duration of two years
to the target population to gauge whether the anticipated impact
of the project is in place. At this level however remedies cannot
be done to the course of the project because implementation is
over and what remains at this point is only assessment of the
impact for reporting purposes. Such reports are useful in future
implementation of similar projects.
Among the impacts anticipated by the project include the
prompt access to attachment opportunities by respective college
students. A key indicator for the achievement of this is the
reduction of the number of people that are faced with the
difficulty of accessing attachment to such institution. However,
the achievement of these results can be due to the intervention
of confounder variables and this means that in this case the
achievement of the envisaged results is not attributable to the
intervention of the project.
The project is estimated to be rolled over for a period of three
months but aspects of the project such as summative assessment
will last longer as their scope go beyond the normal duration of

the project to a time after the project in bid to measuring its
impact.
References
Agnew, M. D., Goodess, C. M., Hemming, D., Giannakopoulos,
C., Salem, S. B., Bindi, M., ... & El-Fadel, M. (2013).
Introduction (pp. 3-21). Springer Netherlands.
Elliott, M. (2002). U.S. Patent No. 6,446,053. Washington, DC:
U.S. Patent and Trademark Office.
O'Leary, Z. (2013). The essential guide to doing your research
project. Sage.
Walden University
Master of Science in Nursing
NURS 6600: Capstone Synthesis Practicum Journal
Student Name: Amanda Swenty

E-mail Address: [email protected]
Practicum Placement Agency's Name: Rasmussen
Preceptor’s Name: Julie Williams
Preceptor’s Telephone: 920-883-2135
Preceptor’s E-mail Address: [email protected]
Practicum Professional Development Objectives
1. By the end of nursing 6600 I will effectively be able to
communicate my role as clinical coordinator to students and
university staff as defined by evidence-based practice
2.
By the end of nursing 6600 I will have undergone the
experience necessary to expand on my conflict resolution skills
from a team member to the level of upper management in order
to be a more effective leader.
3. By the end nursing 6600 I will have acquired the skills
necessary to analyze and effectively evaluate systematically
clinical sites and their efficacy in the college.
Project Objectives
1.
2.
3.
4.

5.
(Continued on next page)
NURS 6600 Practicum Experience Journal
You must submit a journal entry in each assigned week, even if
you are not on-site that week. If you are not on-site for a week
in which a journal entry is due, reflect on experiences from any
of the previous weeks of this course. Journal entries are due in
Weeks 3, 7, and 11. Place the references for each week’s entry
immediately after that week’s content. Remember to use APA
style when writing your journal entries and listing references.
Begin each journal entry on a new page. The template has a
“new page” command inserted before each weekly label. Be
sure to delete any blank pages that appear between the weekly
entries. Note:This document will serve as a cumulative journal.
For each submission, you will add to the document so it
contains all of your journal entries.
Journal Entries
· Describe a problem, issue, or situation that you have observed
during your Practicum Experience not related to your project
(no more than a half page) (10 points)
· Using no fewer than three peer-reviewed sources, analyze
what you have observed within the context of your specialty
using appropriate concepts, principles, and theories, giving
special attention to observed events that vary from scholarly
literature. (30 points)
· Explain how the problem, situation, or issue was handled in a
manner that is consistent and a manner that is inconsistent with
the theory, concepts, and principles detailed in the evidence.
(30 points)

· Given the various evidence-based approaches that can be used
in handling the problem, situation, or issue, formulate a plan for
approaching the matter differently. (30 points)
· Include references immediately following the content.
· Use APA style for your journal entry and references.
Note that Faculty may deduct up to 20 points for writing style
issues/errors and/or citation- or reference-related APA errors.
Please look below under the week three page break for the
format for these journal entries. Practicum Experience Journal
Entries NURS 6600
Week 3 Journal (references should immediately follow the
content)
The issue that I identified at the Rasmussen clinical site was
that the ratio of nurse to patients in the clinical setting appeared
to compromise on the ability of the clinic to discharge quality
medical care to patients. Available nurses were laden with huge
workload making them barely have interpersonal connection
with the patients that they engaged and this contributed to the
failure of the clinic to uphold standards prescribed by
Accreditation Association for Ambulatory Healthcare. The need
to instill quality in the medical services provided to patients is
apparent by medical standards in the institution which are
closely linked to the goals set out by the clinic. However, the
inability of the available workforce to engage the workload
efficiently results to poor medical services as the needs of
clients are not addressed promptly (Katsikitis, McAllister,
Sharman, Raith, Byrne & Priaulx, 2013).
Standards set by American Nurses Association binds provision
of quality medical services to staffing as the ability to discharge
medical care is compromised by unhealthy workloads. Nurse to
bed ratio is a relationship that should be kept in equilibrium for

provision of quality medical services to patients (Rogowski,
Staiger, Patrick, Horbar, Kenny & Lake, 2013).
Approach of making patients as the focus of medical care as
advanced by the Accreditation Association for Ambulatory
Health care was aimed at looking at the needs of patients better.
This however is impacted on the availability of medical
personnel and therefore realization of quality medical care is
akin to suitable nurse to bed ratio (Palese, Cuel, Zanella,
Zambiasi, Guarnier, Allegrini & Saiani, 2013).
The problem can be solved differently through the reliance of
extensive use of modern technology so as to beef up the already
limited staff for them to function better. Revision of the
retrenchment schemes of nurses can be done to alter the process
so as to address this deficit for realization of quality medical
care (Katsikitis, McAllister, Sharman, Raith, Byrne & Priaulx,
2013).
References
Katsikitis, M., McAllister, M., Sharman, R., Raith, L.,
Faithfull-Byrne, A., & Priaulx, R. (2013). Continuing
professional development in nursing in Australia: Current
awareness, practice and future directions. Contemporary nurse,
45(1), 33-45.
Palese, A., Cuel, M., Zanella, P., Zambiasi, P., Guarnier, A.,
Allegrini, E., & Saiani, L. (2013). Nursing care received by
older patients in Italian medical units: findings from an
explorative study. Aging clinical and experimental research,
25(6), 707-710.
Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M.,
& Lake, E. T. (2013). Nurse staffing and NICU infection rates.
JAMA pediatrics, 167(5), 444-450.Practicum Experience
Journal Entries NURS 6600

content)
Issue
Analysis of the Action
Alternative Evidence Based Approach Practicum Experience
Journal Entries NURS 6600
content)
Issue
Analysis of the Action
Alternative Evidence Based Approach
© 2012 Laureate Education Inc.
2
© 2013 Laureate Education Inc.
4
PROPOSED PRACTICUM PROJECT
With the help of the greater green bay healthcare alliance I will
be proposing to standardize the way in which students are
places into clinical sites within the green bay college system for
acute care rotation of AND students. I will contact all hospitals
including BellinHealth, St. Vincent’s, Brown county mental
health center, Aurora, St. Mary’s, and Bay area medical center,
and Oconto falls hospital and Bellin Psych. I am working with
my preceptor Julie a faculty member and clinical coordinator
for Rasmussen College in Green Bay. We will need to be in
contact with and coordinate with NWTC, CMN, GB, and Bellin
College. I hope to develop a standardized tool (computer
program) that will enable everyone to click on website and see

which clinical sites are available and which are taken making it
easier to place students in an acute care clinical site.
Planning to research other clinical placement tools out there and
go from there.
1. By the end of nursing 6600 I will effectively be able to
effectively communicate my role as clinical coordinator to
students and university staff as defined by evidence-based
practice.
2. By the end of nursing 6600 I will have undergone the
experience necessary to expand on my conflict resolution skills
from a team member to the level of upper management in order
to be a more effective leader.
3. By the end nursing 6600 I will have acquired the skills
necessary to analyze and effectively evaluate systematically
clinical sites and their efficacy in the college.
Hey Julie I messed these up the first day boo…maybe you could
take a look at my SMART outcomes and offer me feedback? I
would really appreciate it. I did the assignment wrong on the
first day gah

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