UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
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Licensed Clinical Positions
LVN - SR LVN
Job Description
Performance Evaluation
Period Covered by this Performance Evaluation: _____________ TO _______________
Licensed Vocational Nurse (LVN) & SR. LVN
Employee Name:
Department/Unit:
Supervisor Name:
Supervisor Title:
ANIV
Current Title:
LVN and SR. LVN
Approved Title (for reclassifications only):
Methods of Measurement Include the Following:
☒ Direct Observation
☒ Feedback from staff or patients
Current Title Code:
Approved Title Code (for
reclassifications only):
AGES SERVED
☒ Documentation
☐ PI Reports
☐ Neonates (< 30 days)
☐ Infants (> 30 days and < 1 year)
☐ Pediatrics (> = 1 year & < 13 years)
☒ Adolescents (> = 13 years & 18 years)
☒ Adults (> = 18 years to < 65 years)
☒ Geriatrics (> = 65 years)
☒ Not Applicable
Place an “X” if over 20% of work is exposed to one or more of the following conditions:
☐ Confined area
☐ Exposed to weather
COMPETENCIES:
INITIAL:
☐ Noise Exposure
☐ Vibrations
☒ RR UCLA MC Specific Orientation
ANNUAL: ☒ Department of Nursing
☐ Extreme temperatures
☒ Atmospheric conditions
☒ Department of Nursing and Service
☐ Potential allergenic/irritant conditions
☐ Other (specify)
☒ Unit (Float excluded)
☒ Unit (Float excluded)
SUMMARY STATEMENT:
The Licensed Vocational Nurse must be able to work with a primary nursing model as delivery care systems and follow established University, Hospital, and
Departmental work policies, procedures and guidelines.
D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
TYPE OF SUPERVISION RECEIVED:
Under the direct supervision of an RN.
D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
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1. After initial RN assessment and under RN supervision, assists in assessment of population specific patient care needs
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2. Provides information to the RN that may be used in the assessment of patients
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1. Provides critical assessment data (VS, weight, etc) to assist in the development of Population Specific Nursing Plan of Care
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2. Participates in identifying, developing and/or implementing strategies to ensure continuity of effective care between shifts,
between transfers with units, between or among contact with health care team, according to critical pathways
3. Participates with RN in individualizing practice guidelines according to patient needs
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2. Orients patient to environment and routine of unit
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3. Takes and records patient's vital signs, weight and height as directed
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1. Identifies needs and assists with nursing plan of care for patient/family needs regarding discharge planning, interdisciplinary
referrals
2. Prepares and assists with the collection and transfer of personal items and equipment
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3. Accompanies patient during transport/discharge as needed
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Duties and Tasks
I. PATIENT CARE
A. Assessment
3. Utilizes assessment data to identify and state obvious physiological and psychological problems, symptoms, behavioral
changes and deviations from normal
B. Plan of Care
4. Actions and decisions are based on one or more of the following: standards, practice guidelines, protocols, past experience,
logic, scientific principles, intuition, research
C. Assists patients with admitting procedure:
1. Sets up room for admission and transfers in
4. Cares for patient's personal property, labels and stores personal items, labels door, urinals, bedpans, measuring devices,
water pitchers, and all patient equipment
D. Assists patients during transfer procedure/discharge:
D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
4. Replaces bed and bedside tables as needed
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1. Provides for patient's personal hygiene
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2. Assists and feed patients as needed
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3. Documents food intake for calorie count as ordered
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Assists in providing patient safety and comfort measures:
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1. Follows standard precautions for all patients
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2. Maintains and reinforces isolation policy
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3. Implements and maintains heel protectors, special mattress/bed and other pressure reduction devices as directed
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4. Applies and monitors restraints as directed per hospital protocol.
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5. Maintains individual patient safety, e.g., side rails up, brakes locked and call bells within reach, and initiates fall precautions as
directed
6. Responds to emergency situations per hospital protocol
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7. Tags/reports malfunctioning equipment to appropriate personnel
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8. Responds to/reports alarms immediately to RN
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G. Maintains a clean and orderly environment:
1. Changes bed linen on a routine basis and as needed
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2. Assists in tidying patients' rooms and personal effects
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3. Keeps bedside supply trays stocked per unit protocol
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4. Maintains cleanliness of patient's special equipment
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5. Removes unused equipment and/or supplies from room and places in designated area for pick-up or storage
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6. Routinely checks each patient's bedside to ensure that call bell, light and room clock are accessible and functioning
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E. Assists with activities of Daily Living
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D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
7. Assists in the identification of environmental (i.e. frayed cords, spills, wet floors, etc.) hazards and reports to appropriate
personnel
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Keeps corridors uncluttered
● Removes or arranges for removal of unnecessary equipment
● Maintains neatness of linen rooms
● Empties linen hampers as appropriate and keeps all linen off the floor
9. Maintains refrigerator logs as directed
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10. Performs/assists with ER cart and defibrillator checks as directed
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11. Maintains unit based equipment as directed
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1. Assembles suction equipment
2. Fills humidifier bottles when not attached to patient
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3. Suctions oral cavity as directed/needed
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4. Assists patient with incentive spirometer
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5. Performs CP (chest percussion) as directed
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6. Assists patients in coughing, deep breathing and position changes as directed
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7. Provides trach care and suctions as necessary
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1. Takes and records height and weight, intake and output, temperature, pulse, respiration, blood pressure, pain and/or pulse
oximetry as directed
2. Completes required documentation on flow sheets per unit protocol
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3. Administers and documents medication according to policy
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4. Performs phlebotomy if State Certified
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5. Places and maintaince IV-if State Certified
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II. SKILLS AND PROCEDURES
A. Assists with respiratory care:
B. Performs procedures within the LVN scope of practice as directed
D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
6. Sets up and maintains monitoring equipment
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7. Douches/irrigations/gastric feeding
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8. Empties drainage bags (Indwelling, Jackson-Pratt, and Hemovac)
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9. Assists with sterile/non-sterile dressing changes and wound care
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10. Hot and cold application
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11. Provides pre-op scrubs and preps as directed
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12. Assists in removing or taping of jewelry, removal of dentures or other articles (wigs, glasses, etc.)
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13. Labels with patient's name and ID, secures and stores all belongings when patient is not returning to assigned room
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14. Prepares beds for post-operative/procedural patients
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15. Performs the role of a Monitor Tech. as directed
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16. Performs EKG as directed
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1. Assists patient in position changes, dangling and ambulation
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2. Assists patient in and out of bed
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3. Assists in the application and removal of anti-embolic and pulsatile stockings, as directed
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4. Assists with PT/OT Care such as:
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a. Range of motion
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b. Transfers
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d. Application of splints, prosthetics and orthotic support devices
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e. Feeding for dysphagia patients
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C. Assists patient with activity and mobility
Endurance activities
ADL practice/training for home care
D - Does Not Meet Expectations
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M-
Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
D. Performs special procedures as directed:
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1. Sitz bath
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2. Breast care
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3. Perineal care
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4. Provides Seizure precautions as directed
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5. Provides patient observation as assigned
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6. Assists with post-mortem care
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a. Assists with care and labeling of body according to policy
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b. Assists with packing, labeling and transferring of belongings
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1. Facilitates a calm, orderly and quiet environment
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2. Coordinates flows of communication between appropriate staff
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3. Answers patient call lights in a courteous and timely manner, as appropriate
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4. Respects customer/staff individuality
5. Consistently models exceptional interpersonal skills and caring behavior in working with patients, significant others and
members of patient care team
6. Effectively responds to the unique needs of neonatal, pediatric, adolescent, adult, and/or geriatric patients as needs arise
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7. Assists with directing flow of visitors to the Unit
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1. Assists with checking an stocking cart supplies and assists with charging of patient charge items
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2. Assists in tracking and inventory of equipment
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E. Performs skills and procedures as directed by the RN
III. CUSTOMER RELATIONS
IV. MISCELLANEOUS DUTIES
A. Assists with duties as assigned by the charge nurse/shift coordinator:
D - Does Not Meet Expectations
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M-
Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
3. Participates in Nursing Department committees or projects and communicates outcomes to staff and Unit Director/Clinical
Nurse Manager
4. Picks up and delivers supplies as directed
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1. Assists in orienting new personnel
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2. Participates in work-related continuing education and communication activities
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3. Assists in involving the patient/family in design of their teaching plan
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4. Participates in providing informal teaching to staff and student on the unit
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5. Utilizes structured patient teaching tools to meet the patient family learning needs
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V. TRAINING
A. Demonstrates a willingness to assist other members of the team while maintaining performance of individual duties
VI. UCLA C-I-CARE/Patient Experience Practices: MY COMMITMENT TO CARE
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Observe and practice all the Service Standards listed in the “World Class Practices” (which I have read and signed)
o Practice C-I-CARE when interacting with patients, their families, visitors, or internal customers
o Connect with the patient and family members by addressing them as Mr./Ms., or by the name that they prefer
o Introduce yourself and your role
o Communicate what you are going to do, how long it is going to take, and how it will impact the patient.
o Ask and anticipate patient and/or family needs, questions or concerns
o Respond to patient and/or family questions and requests with immediacy
o Exit courteously and/or with an explanation of what will come next (or when you will be back to check on them)
o Practice C-I-CARE phone etiquette during all phone interactions
Always exercise courtesy whenever patients, family members, visitors and co-workers are present
o Respect privacy and dignity of our patients, family members, visitors and co-workers
o Maintain professionalism in the presence of patients, their families, visitors and co-workers
Observe departmental Patient Experience plan, competencies and practices
o Act as a role model, verbally and behaviorally demonstrating skill, enthusiasm, positive problem solving, commitment
and loyalty to the profession and the organization
o Participate in positive problem solving by providing suggestions and possible solutions to identified concerns/problems
in the work place
D - Does Not Meet Expectations
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Meets Expectations
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N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
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Licensed Clinical Positions
LVN - SR LVN
Comply with Health System Workplace Conduct Policy
o Engaging in disruptive behaviors that interfere with or prevent normal work functions or compromise patient safety,
including passive or active behaviors will not be tolerated as stated in the HS Workplace Conduct Policy
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Comply with Health System Dress Code Policy and practices
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VII. INSTITUTIONAL AND/OR PROFESSIONAL STANDARDS
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Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
Comply with Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies
standards
Adhere to all Hospital Policies and Procedures
Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the
annual education module
Demonstrate adherence to the requirements for using the electronic medical record
Demonstrates understanding of institutional and department specific emergency management procedures/responsibilities to
maintain personal, patient, and co-worker safety, maintains competencies in these areas, and participates in
disaster/emergency related exercises and education.
Demonstrates understanding of institutional and department specific safe patient handling procedures/responsibilities
and maintain a level of competency on the proper use of departmental lift equipment to ensure personal, co-worker and
patient safety
VIII. PERFORMANCE IMPROVEMENT
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Adhere to current organizational Performance Improvement priorities
Participate in quality studies through data collection and dashboard data collection
Make recommendations and take actions to improve structure, system or outcomes
D - Does Not Meet Expectations
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Meets Expectations
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N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
OTHER DUTIES
Skills, Knowledge and Abilities
(Disregard this section for performance evaluations)
REQUIREMENTS:
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CPR:
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License:
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Certifications:
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Degree:
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Experience:
List any equipment (machines, tools, office appliances or motor vehicles) required to do the job, with or without a reasonable
accommodation. Indicate whether use is seldom, occasional, frequent, or constant.
LVN
See Nursing Policy/Procedure /Equipment manual
State IV & Phlebotomy
D - Does Not Meet Expectations
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Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Importance:
Required or
Preferred
Skills, Knowledge and Abilities
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Licensed Clinical Positions
LVN - SR LVN
Knowledge of basic computer fundamentals
Ability to speak clearly and distinctly using appropriate English vocabulary and grammar
Ability to understand oral and written directives
Ability to read and write Standard English text
Ability to perform basic arithmetic computations (add, subtract, multiply, and divide)
Demonstrates an understanding of medical terminology and abbreviations
Ability to organize and prioritized work to complete assignments in a timely manner
Required
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Required
New Hire:
LVN - New Grad IV and Phlebotomy Certification required within 6 months of hire
SR. LVN - More than 6 months experience as an LVN in the current position or has relevant clinical experience
If overall rating is “Does Not Meet Expectations”, please complete Future Plans and Actions Section.
According to the Employee Performance Evaluation Policy, an overall rating of “Does Not Meet Expectations” requires an action plan and a
follow-up performance evaluation in either a three-month or six-month period depending on the time needed to demonstrate improved performance.
Action plan steps must be objective and measurable with a defined time frame. The date of the follow-up performance evaluation will reset the
performance evaluation due date.
Does Not Meet Expectations ☐
Meets Expectations ☐
Comments:
Future Plans and Actions:
D - Does Not Meet Expectations
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M-
Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria
UCLA Health System
JOB DESCRIPTION/PERFORMANCE EVALUATION
Licensed Clinical Positions
LVN - SR LVN
Employee Comments:
To update our files, please answer the following questions:
Have you received a higher education degree in past 12 months:
Yes______No______
If Yes, in what field:_______________________________________
Type:_____________
Have you received a national certification in the past 12 months:
Yes______No______
If yes, please list and bring a copy of certificate to Nursing Resources:__________________
Employee Signature
I have reviewed this Job Description and/or Performance Evaluation
Date
Evaluator Signature
Date
Department Head or Designee Signature
Date
D - Does Not Meet Expectations
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M-
Meets Expectations
N/A - Not Applicable
Revised 4/2013
Directions:
You have the option of checking the large boxes next to the headings or of checking the small boxes to indicate performance for each criteria