RN Case Manager RN Peer Input Tool for Annual Evaluation:
Collaboration, Communication, and Professional Relationships
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
DOMAIN: Collaboration Communication, and Professional Relationships: Working with others in a way that promotes
and encourages each person’s contributions. It involves inter- and intra-disciplinary work with colleagues and ability to negotiate
and resolve conflict.
Valuing Teams/Teamwork
Engaged, active team member
and leader.
Fosters mutual regard, respect,
and trust within the team.
Recognizes role of each
member of the
interprofessional team.
Is sought out by members of the
interprofessional health care
team.
Demonstrates empathy and
compassion in interactions with
team members.
Creates conditions and
relationships that promote
creative, innovative, and positive
processes and outcomes.
Demonstrates team values that
motivate people to care about
the performance and success of
others.
Through shared values and a
clear professional identity,
demonstrates and role models
an interprofessional
collaborative approach to
patient care.
Negotiation/Conflict Resolution
Approaches conflict situations
in a constructive manner.
Fosters other’s development of
conflict resolution skills.
Provides and accepts feedback
with a positive approach.
Employs conflict resolution skills
in maintaining relationships and
resolving challenging situations
(I.e., Crucial conversations)
Demonstrates active
engagement to enhance
patient care and promote a
positive workplace
Demonstrates team values that
orient people to care about the
performance and success of
others
Recognizes value of conflict in
individual and organization
learning and growth.
Employs negotiation skills in
building and maintaining
relationships and resolving
challenging situations (I.e.,
mutual gains, interest-based)
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Please describe a time when you saw me at my very best. What qualities did I display in this domain?
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 7/2015 Professional Development Framework RSAM Steering Committee/JIT Approved.
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