Educational Nurse Coordinator RN Peer Input Tool for Annual Evaluation:
Contribution
Peer feedback for (RN name):
Directions:
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Evaluatee to send domain portions to peers who evaluatee would like feedback from
Clinical Thinking and Judgment domain is to be completed by another RN
Peers should indicate within the last column the level they feel is appropriate for the Evaluatee on each row
Peers are encouraged to support their views with concrete examples
Peers should complete the peer review within 7 Days and return electronically to the Manager/Designee and Evaluatee
Role Entry / Competent
Expert
Mastery
Peer Should Designate
Appropriate Level Below
Contribution: (See underlined/colored behaviors under the domain of Facilitator of Learning and Professional Development--these behaviors reflect the Contribution domain)
Participates in unit and wider
educational meetings and
forums
Recognizes the
interrelationships that exist
across our systems
Collaborate with recruitment
and retention initiatives with
regard to growing and
strengthening with the nursing
workforce
Collaborates with schools of
nursing and other departments
to ensure mutual benefits for
educational purposes
Independently and creatively
designs curricula and learning
interventions that are evidencebased (pedagogy, not just
clinical evidence) within the
unit/area and beyond
Creatively and dynamically
presents/implements on unit
and beyond consistent with
broad institutional vision,
mission, values, and goals
Membership in professional
organization
Implements CE Program
Presents at educational
programs within the unit/area
and institution
Represents educational mission
and work in every venue in
which they practice
Participates in the promotion of
an environment that embraces
diversity in the workplace
Mentors others to assume
leadership roles within the
Professional Practice Model
Creates and improves
partnerships, functions as liaison
to accomplish educational goals
Collaborates with outside
agencies and professional
organizations to endure mutual
benefits for educational
purposes
Mentors others in educational
processes
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Role Entry / Competent
Expert
Mastery
Peer Should Designate
Appropriate Level Below
Contributes to the available
knowledge/evidence in relation
to education of practicing nurses
Evidence of advancing
professional identity:
 Active participation in
professional organization,
ie: NNSDO, specialty
 Certification in education
 Formal education (e.g.:
certificate, MSN, etc)
 Publishing articles in
professional nursing
literature
Presentation at regional or
national meetings
Models and teaches
responsiveness to diversity
Challenges the status quo to
assure the actualization of
diversity in the workplace
Independently seeks out
opportunities to influence
evidence based nursing practice
through the educational process
Participates in research (e.g.:
evaluation, research, specialty
research, etc.) and shares
findings in larger forums
Applies performance
improvement methodologies
(PDCA) to continuously enhance
programmatic impact and
contribution to strategic aims
Please describe a time when you saw me at my very best. What qualities did I display in this domain?
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Please provide your input regarding opportunities for my personal and/or professional growth
I have completed the Peer Feedback Class as required by the UMPNC contract, paragraph 28E, for participation in the
peer review process.
Name:
Date:
Revised 5/1/09 Professional Development Framework RSAM Steering Committee/JIT Approved.
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