Mid‐Term
Assessment
of
Clinical
Experience
Clinical
Course
___________________
Instructor
________________________
School__________________________
Clinical
Area
Assigned______________
Did
the
orientation
packet
provide
you
with
information
and
resources
needed
for
your
clinical
experience?
Yes
___No___
Comments:
_______________________________________________________
Using
4‐point
rating
scale
to
determine
answers
(1=Never
2=
Rarely
3=Occasionally
4=Often),
please
rate
how
well
staff
is
maintaining
an
environment
conducive
to
professional
practice
and
growth.
Environment
Provides
a
helpful
and
supportive
workplace
for
you
in
your
role
as
a
student
Provides
effective
role
models
for
problem
solving,
communication,
and
teamwork.
Demonstrates
high
morale
and
harmonious
working
relationships.
Rating
Identify
the
ratio
of
students
to
nurses
for
your
clinical
experience:
_____1
student
to
1
nurse
_____2
students
to
1
nurse
_____greater
than
2
students
to
1
nurse
‐
Describe___________________________
What
suggestions
would
you
offer
to
the
clinical
site
that
would
improve
this
educational
experience?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
All
completed
evaluation
forms
should
be
returned
to
the
Clinical
Education
Department.