UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool
Date ______
Pts
Student________________________
5
Level of
Performance
Exceptional
4
Proficient
3
Good
2
Acceptable
1
Unacceptable
0
Unsafe
Faculty _______________________ Mid-term Evaluation / Final Evaluation (Circle One)
Evaluation Criteria
Self-directed, proactive, & accountable Seeks guidance and updates instructor with appropriate independence. Utilizes time for maximum
learning. Applies knowledge and performs with insight and depth that is above expectations.
Requires minimum guidance. Often self-directive, proactive, & accountable. Exhibits eagerness to learn. Updates instructor with appropriate
independence. Applies knowledge and performs with moderate insight and depth.
Requires moderate guidance and prompting by instructor. Steady performance improvement. Applies knowledge and performs with some
insight and depth.
Requires frequent direction from instructor to meet performance criteria. Minimally self-directive; Meets minimal standards and performs
safely. Applies basic knowledge but is lacking in insight or depth.
Not self-directed. Inconsistent in meeting clinical expectations. Unsafe patterns of behavior. May require remediation. Conference with
summary with course coordinator required.
Harms or places the patient at high risk for harm. May result in failing the course or disciplinary action. Conference with summary with
course coordinator required.
Non- Points
Categories
Evaluation Criteria
Satisfactory
Unsatisfactory
Demonstrates competency and meets performance indicators.
Does not meet basic performance indicators or breaches standards of care.
Note:
All students will receive a mid-term and final clinical evaluation. For the mid-term evaluation, students who receive less than a level 2 or an unsatisfactory rating in
any Student Learning Outcome (SLO) category are required to meet with the clinical faculty and the course coordinator. On the final evaluation, the student must
achieve a minimum of a level 2 performance or satisfactory in each of the ten SLO categories to pass the course.
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UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool
Student
Performance Descriptors
Learning Outcomes
 Provides compassionate, respectful, and non-judgmental
patient care.
Patient Centered
 Identifies patient’s developmental stage, cultural needs
Care
and preferences.
 Describes the role of the nurse.
 Identifies basic patient teaching needs related to safety.
 Begins to prioritize nursing diagnosis.
 Demonstrates basic patient care and comfort measures.

Clinical
Reasoning &
Judgment





Evidence-Based
Practice

Demonstrates developing skill and timely physical
assessment.
Identifies significant patient cues (physical assessment).
Begin to prioritize nursing care based on assessment
data.
Asks pertinent questions before performing nursing care
activities to ensure patient safety.
Identifies and evaluates goal-directed therapeutic
nursing interventions.
Engages in meaningful self-reflection of professional
practice.
Student Comments
Faculty Evaluation
Performance Score
( 0-5 scale) (0-10 points)
Weighted X2
( 0-5 scale) (0-5 points
Uses reliable sources of information to plan care.
.Identifies EBP interventions.
( 0-5 scale) (0-5 points)
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UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool

Communication




Information &
Technology

Begins to utilize effective verbal and non-verbal
communication skills with all individuals.
Communicates effectively using SBAR to convey
relevant data acquired about the patient.
Clarifies role with RN and other members of healthcare
team including unlicensed personnel.
Incorporates medial terminology accurately and
appropriately while communicating.
Requests need for help when appropriate to situation.
( 0-5 scale) (0-10 points)
Weighted X 2
Protect confidentiality of protected health information in
the EMR in an ethical manner.
Satisfactory Unsatisfactory
Quality
Improvement &
Safety





Assess and implement interventions to ensure patient
safety.
Reports concerns related to hazards and errors.
Complies with universal and transmission-based
precautions.
Uses assessment tools to identify patient risks: Morse
Fall Scale and Braden Scale
Describes protocols to ensure quality of care.
( 0-5 scale) (0-5 points)
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UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool

Professionalism





Collaboration
&
Teamwork




Leadership


Systems Based
Practice


Demonstrates core professional values (caring, altruism,
autonomy, integrity, human dignity, and social justice).
Complies with Code of Ethics, Standards of Practice,
and policies and procedures of the University of Central
Oklahoma: Department of Nursing, and clinical
agencies.
Accepts constructive feedback and develops a plan of
action for improvement.
Demonstrates expected behaviors and complete tasks in
a timely manner.
Arrives to clinical experiences on time and prepared.
Maintains professional behavior and appearance.
Respectfully acknowledges differing views.
Maintains a positive attitude when interacting with team
members, faculty, and fellow students.
Begins to identify strengths and limitations as a team
member.
Actively participates in pre and post conference
activities.
Advocates by communicating concerns to the clinical
instructor related to patient well-being.
Supports and motivates peers during clinical and post
conference.
( 0-5 scale) (0-5 points)
( 0-5 scale) (0-5 points)
( 0-5 scale) (0-5 points)
Demonstrates an awareness of research management and
cost containment.
Works effectively within the healthcare system.
Satisfactory Unsatisfactory
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UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool
Note: The student must achieve a level 2 or satisfactory performance in each SLO category on the final evaluation to pass the course. After
determining the student is at the minimum level of performance in all categories, total the student’s points in the column.
Grade – (based on conversion table below).
Exceptional Performance:
50 Points = 100%
48-49 Points = 97%
47-46 Points = 94%
Proficient Performance
45-44 Points – 92%
44-42 Points – 89%
41- 40 Points – 87%
Good Performance
39-37 - 86%
36 -34 – 85%
33-30 - 83%
Acceptable Performance
29-25 Points – 82%
21-24 Points -78%
20 Points =76%
Faculty Comments:
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UNIVERSITY OF CENTRAL OKLAHOMA – Department of Nursing
Foundations
Clinical Performance Evaluation Tool
Student Signature: __________________________________
Date: ___________________
Instructor Signature: _________________________________
Date: ___________________
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