LPN Outpatient Manager Tool
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MANAGER / ASSISTANT MANAGER / CHARGE NURSE FEEDBACK TOOL: Outpatient Areas
Subject’s Name: ___________________________________ Evaluator’s Name: _________________________________
Requires Evaluation Descriptors (Quality & Effect on Team) for reference
PLANNING & MANAGING CARE
Job
Description
1. Practice adheres to specialty and
organizational standards.
LPN 1-4
2. Addresses patient safety needs
LPN 1-4
3. Applies age-specific/cultural
considerations to care of patient.
LPN 1-4
4. Participates with triages patient care.
LPN 1-4
5. Appropriately communicates changes in
patient condition.
LPN 1-4
6. Patients and families are satisfied with
the care this nurse has given.
LPN 1-4
7. Identifies patient problems that need to
be referred to PCP or provider other
than this clinic.
LPN 2-4
8. Manages patient flow and identifies
problems that impede patient flow for
Quality/
Expertise
Effect
on
Team
Specific /Example(s) recommended for above level
criteria; especially in support of advancement
LPN 2-4
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
Page 2 of 9
maximum efficiency.
9. Takes on additional clinical
responsibilities and/or assists others.
LPN 2-4
10. Organizes work and manages changes
in work demands for effective use of
time.
LPN 2-4
11. Delegates to staff appropriately, with
consideration for other team members’
workload.
LPN 2-4
12. Manages complex clinical situations.
LPN 2-4
It is required to describe specific example(s) for each Key Function. Please enter specific example(s) below:
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
CONTINUUM OF CARE PLANNING
Discharge or transfer to the next level of care
planning.
Page 3 of 9
Job
Description
1. Identifies pt/family needs and
implements plan for movement to next
level of care.
LPN 1-4
2. Uses internal & external referrals &
resources that support pt/families
through continuum of care.
LPN 1-4
3. Integrates observed patient information
into plan for next level of care in
unexpected, changing and complex
situations.
LPN 3-4
4. Acts to participate in resolution of
system breakdowns, knowledge or
behavior issues that impact continuum
of care needs.
LPN 3-4
Quality/
Expertise
Effect
on
Team
Specific /Example(s) recommended for above level
criteria; especially in support of advancement
It is required to describe specific example(s) for each Key Function. Please enter specific example(s) below:
Identify this during the training for managers with examples (1 and 3)
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
PATIENT / FAMILY EDUCATION
Page 4 of 9
Job
Description
1. Incorporates a variety of resources to
teach and support pt and family learning
(e.g.: EZTV, patient education materials,
web sources, drawings, etc).
LPN 1-4
2. Participates in the individualization of
patient/family education for complex
patients/families (Ex: resistant, noncompliant, significant barriers to
learning).
LPN 3-4
3. Leads or co-leads development/
revision/use of teaching tools/aids for
specific population(s) within the last
year.
LPN 4
Quality/
Expertise
Effect
on
Team
Specific /Example(s) recommended for above level
criteria; especially in support of advancement
It is required to describe specific example(s) for each Key Function. Please enter specific example(s) below:
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
PROBLEM SOLVING
Page 5 of 9
Job
Description
1. Identifies and takes action to report or
resolve patient safety-related problems
and other clinical issues.
LPN 1-4
2. Identifies and takes action to report or
resolve system problems (operational or
workaround).
LPN 1-4
3. Follows appropriate chain of command
when problem solving.
LPN 1-4
4. Actively participates in team/group
problem solving.
LPN 1-4
5. Positively supports change.
LPN 1-4
6. Is a consultant to manager or other
leaders (E.g.: clinical, proposed
changes, departmental enhancements).
LPN 3-4
7. Uses interdisciplinary approach to lead
others in problem solving projects and
evaluates outcomes using data.
LPN 4
Quality/
Expertise
Effect
on
Team
Specific /Example(s) recommended for above level
criteria; especially in support of advancement
It is required to describe specific example(s) for each Key Function. Please enter specific example(s) below:
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
COMMUNICATION & COLLABORATION
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Job
Description
1. Personal behavior positively influences
environment and others (may include
attendance, tardiness, or team support).
LPN 1-4
2. Accesses HCT as needed to implement
plan of care/meet patient’s needs.
LPN 1-4
3. Effectively communicates and
collaborates with patients and families.
LPN 1-4
4. Effectively communicates and
collaborates with staff and other HCT
members.
LPN 1-4
5. Communicates positively and
constructively in stressful situations.
LPN 1-4
6. Provides accurate and objective
feedback in a respectful and
professional manner while maintaining
confidentiality.
LPN 1-4
7. Completes assigned evaluation tools
within designated timeframe (E.g.: end
of orientation, self report, peer
feedback).
LPN 1-4
Nursing Research Office – Vanderbilt Univ. Medical Center
Quality/
Expertise
Effect
on
Team
Specific /Example(s) recommended for above level
criteria; especially in support of advancement
Reviewed 04/2013
LPN Outpatient Manager Tool
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8. Receives peer feedback in a respectful
and professional manner.
LPN 1-4
9. Facilitates internal and/or external
customer satisfaction
LPN 1-4
10. Participates directly in and/or supports
orientation of new staff.
LPN 2-4
It is required to describe specific example(s) for each Key Function. Please enter specific example(s) below:
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
Page 8 of 9
Evaluation Scoring Descriptors Effective May 2006
For each criterion, evaluator considers 2 dimensions and chooses only 1 descriptor for each:
 How well the subject performs this behavior, the quality or degree of expertise
 The subject’s effect of the team when performing this behavior
Quality / Expertise
Effect on team
a
Does not perform
a
Unaware or ignores standards and/or direction
b
Performs inconsistently or not to standard
b
Requires much direction
c
Consistently competent = performing to standard
c
Requires some support = what would be expected of a new nurse within their first year
d
Performs independently
consistently
d
Consistently proficient = model performance
exceeding standard with big picture view
Consistently an expert = exceptional, masterful
e
performance, specialist
e
Role model & resource to others (beyond precepting) = a positive example for others to try to
meet; demonstrates knowledge & expertise that others recognize and go to (outside the preceptor
relationship), personal behavior demonstrates interest in sharing knowledge/expertise with others
Initiates informal coaching 1:1 with others (beyond precepting) = Takes opportunities to share
f
Benner’s definitions for above descriptors:

Competent = uses experience-based practical
knowledge to apply this criteria appropriately and
efficiently while mindful of goals

Proficient = has achieved a global “big picture”
perspective, attends to total situation, proactive

Expert = highly skilled performance intuitively
knowing what to do and expected results
expertise with the intention of facilitating other’s professional development

Isn’t waiting until asked (resource), sees a situation and spontaneously coaches

Not telling how, but uses questions, etc. to prompt critical thinking

Random, and persons and topics vary
Facilitates improved group practice = beyond 1:1 individual coaching, does something to improve
g
the practice group’s performance:

In-service

Poster, posting, group email

Develop or update a standard, protocol, etc.

Debrief a critical incident for the benefit of the group present
Formally mentors individuals &/or groups by mutual agreement =
h
Individual

Active, personal relationship by mutual agreement focused on specific personal &/or
professional goals
Group

Commits to perform an operational or clinical activity or service for a group or practice area,
e.g. chart rounds, competency training, review of policies, pathways, area super-user, etc.
Instructions continued on next/back page
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013
LPN Outpatient Manager Tool
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As the evaluator
 read each criteria- even above level criteria
 choose the 1 descriptor for each of the 2 dimensions that fits best with the subject’s performance of that specific criteria
 If above level criteria is not applicable, skip it, do not select any descriptors
The selected descriptors eventually are tallied from all evaluation tools into overall key function scores related to the subject’s LPN level
One specific example is required for each key function: Planning & Managing Care, Patient/Family Ed, etc.
For advancement evaluations only: One specific example is required for each LPN 3-4 level criteria in addition to key function examples
If one example will cover > 1 criteria or key function, you can refer to it rather than add another
Nursing Research Office – Vanderbilt Univ. Medical Center
Reviewed 04/2013